Perioperative Management of the Lung Graft Following Lung Transplantation

Evolution of Recipient Characteristics Over 3 Decades and Impact on Survival After Lung Transplantation

“…Severe PGD is considered the most significant threat for early outcomes after LTx, causing major postoperative morbidity and mortality. 22 Kozower et al 23 have reported an increased incidence of PGD and intensive care stay after implementation of LAS. 23 Kreisel et al 24 reported lower survival in patients with postoperative PGD in their series of 1000 LTx.…”

Critical Care Management Following Lung Transplantation

“…The goals of MV following lung transplantation are to promote graft function, maintain adequate gas exchange, and prevent ventilator-induced lung injury [ 7 ]. There have been no large, multicenter trials to guide MV management after lung transplantation despite the critical role of MV in lung transplantation, and only a few studies have addressed appropriate MV after lung transplantation [ 22 , 23 ].…”

“…The spectrum of early postoperative complications after lung transplantation includes primary graft dysfunction, arrhythmias, infections, non-pulmonary organ failure, and anastomotic and pleural complications, as well as postoperative bleeding [ 6 ]. Therefore, prevention and adequate management of these complications in the early postoperative period may have a significant impact on lung graft function and clinical outcomes [ 7 ]. Some complications may be preventable or easy to recover from if managed appropriately.…”

“…Some complications may be preventable or easy to recover from if managed appropriately. However, the management strategies are relatively unclear since robust evidence from systematic evaluations or clinical trials is not fully available in many situations [ 6 , 7 ]. In addition, other basic issues contribute to the increased difficulty of caring for recipients in the ICU, including mechanical ventilation (MV) support and hemodynamic management.…”

ERS International Congress, Madrid, 2019: highlights from the Respiratory Infections Assembly

“…In the context of a constant increase in the number of organ donors and lung transplants, and improved pre-transplant treatment and noninvasive support for advanced disease, extracorporeal life support (ECLS) has become extremely relevant for patients referred for lung transplant procedure. Prof. Corris highlighted that ECLS has an established indication as a bridge to transplant in patients who have been evaluated and accepted for this procedure, and has potential indications in highly selected cases: 1) bridge to transplant decision in potentially eligible patients who have not yet been evaluated, and 2) bridge to recovery in patients with untreated or undertreated pulmonary hypertension or with a treatable cause of right ventricle failure [85,86]. ECLS has also become an established strategy for the support of patients with grade 3 primary graft dysfunction after lung transplantation.…”