Post Lung Transplant Patient 

 

 

Considerations

 

  • Allograft physiology:

    • Heterogeneous compliance, impaired cough, disrupted lymphatics

  • Need for differential lung ventilation if single lung transplant 

  • Extrapulmonary features of underlying disease requiring transplant (e.g., sarcoidosis, cystic fibrosis):

    • Pulmonary hypertension, RV failure

  • Complications:

    • Allograft rejection

    • Vascular & bronchial anastamotic complications

  • Immunosuppression:

    • Strict aseptic techniques, watch for infection

    • Side effects: hematologic, renal, hepatic

 

 

Goals/Conflicts

 

  • Assess allograft function, anastamotic integrity, end-organ function

  • Employ regional/neuraxial anesthesia if feasible

  • If endotracheal intubation & PPV are required:

    • Consider differential lung ventilation

    • Lung protective ventilation to allograft & CPAP with 100% oxygen to native lung

    • Restrictive fluid strategy

  • Strict aseptic technique, avoidance of manipulation of airways, prophylactic antibiotics