Acute postoperative management after lung transplantation

Despite many advances in the field of lung transplantation, lung transplant recipients have the lowest median survival of any solid organ transplant population. Complications such as reperfusion injury, graft rejection, infection, and anastomotic breakdown increase morbidity and mortality during the immediate postoperative period. Ventilator management with lung protective strategies can not only minimize ventilator time and mitigate the risk of ventilator-associated pneumonia, but it may also decrease the risk of primary graft dysfunction and graft failure. Maintaining fluid balance, pain control, and preserving renal function also decrease postoperative complications. Advancements in immunotherapy with the use of calcineurin inhibitors and monoclonal antibodies have been shown to decrease the incidence of acute rejection. However, when unexpected complications occur, appropriately timed rescue therapies such as the initiation of extra-corporeal membrane oxygenation, retransplantation, and plasmapheresis are important considerations geared toward a positive transplant outcome.