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Review Article| Volume 44, ISSUE 1, P105-119, March 2023

Critical Care Management of the Lung Transplant Recipient

  • Jake G. Natalini
    Correspondence
    Corresponding author.
    Affiliations
    Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University Grossman School of Medicine, 530 First Avenue, HCC 4A, New York, NY 10016, USA
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  • Emily S. Clausen
    Affiliations
    Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce Street, 9036 Gates Building, Philadelphia, PA 19104, USA
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      References

        • Chambers D.C.
        • Cherikh W.S.
        • Harhay M.O.
        • et al.
        The international thoracic organ transplant registry of the international society for heart and lung transplantation: thirty-sixth adult lung and heart-lung transplantation report-2019; focus theme: donor and recipient size match.
        J Heart Lung Transplant. 2019; 38: 1042-1055
        • Chambers D.C.
        • Perch M.
        • Zuckermann A.
        • et al.
        The international thoracic organ transplant registry of the international society for heart and lung transplantation: thirty-eighth adult lung transplantation report - 2021; focus on recipient characteristics.
        J Heart Lung Transplant. 2021; 40: 1060-1072
        • Chiumello D.
        • Coppola S.
        • Froio S.
        • et al.
        Extracorporeal life support as bridge to lung transplantation: a systematic review.
        Crit Care. 22 2015; 19: 19
      1. Organ procurement and transplant network. Lung allocation score (LAS) calculator.
        (Available at) (Accessed April 27, 2021)
        • Davis S.Q.
        • Garrity Jr., E.R.
        Organ allocation in lung transplant.
        Chest. 2007; 132: 1646-1651
        • Hayanga A.J.
        • Aboagye J.
        • Esper S.
        • et al.
        Extracorporeal membrane oxygenation as a bridge to lung transplantation in the United States: an evolving strategy in the management of rapidly advancing pulmonary disease.
        J Thorac Cardiovasc Surg. 2015; 149: 291-296
        • Hayanga J.W.A.
        • Hayanga H.K.
        • Holmes S.D.
        • et al.
        Mechanical ventilation and extracorporeal membrane oxygenation as a bridge to lung transplantation: closing the gap.
        J Heart Lung Transplant. 2019; 38: 1104-1111
        • Hakim A.H.
        • Ahmad U.
        • McCurry K.R.
        • et al.
        Contemporary outcomes of extracorporeal membrane oxygenation used as bridge to lung transplantation.
        Ann Thorac Surg. 2018; 106: 192-198
        • Peek G.J.
        • Mugford M.
        • Tiruvoipati R.
        • et al.
        Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial.
        Lancet. 2009; 374: 1351-1363
        • Burki N.K.
        • Mani R.K.
        • Herth F.J.F.
        • et al.
        A novel extracorporeal CO(2) removal system: results of a pilot study of hypercapnic respiratory failure in patients with COPD.
        Chest. 2013; 143: 678-686
        • Tiruvoipati R.
        • Buscher H.
        • Winearls J.
        • et al.
        Early experience of a new extracorporeal carbon dioxide removal device for acute hypercapnic respiratory failure.
        Crit Care Resusc. 2016; 18: 261-269
        • Bermudez C.A.
        • Zaldonis D.
        • Fan M.H.
        • et al.
        Prolonged use of the hemolung respiratory assist system as a bridge to redo lung transplantation.
        Ann Thorac Surg. 2015; 100: 2330-2333
        • Downey P.
        • Ragalie W.
        • Gudzenko V.
        • et al.
        Ambulatory central veno-arterial extracorporeal membrane oxygenation in lung transplant candidates.
        J Heart Lung Transplant. 2019; 38: 1317-1319
        • Biscotti M.
        • Gannon W.D.
        • Agerstrand C.
        • et al.
        Awake extracorporeal membrane oxygenation as bridge to lung transplantation: a 9-year experience.
        Ann Thorac Surg. 2017; 104: 412-419
        • Fuehner T.
        • Kuehn C.
        • Hadem J.
        • et al.
        Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation.
        Am J Respir Crit Care Med. 2012; 185: 763-768
        • Willers A.
        • Swol J.
        • Buscher H.
        • et al.
        Longitudinal trends in bleeding complications on extracorporeal life support over the past two decades-extracorporeal life support organization registry analysis.
        Crit Care Med. 2022; https://doi.org/10.1097/CCM.0000000000005466
        • Nunez J.I.
        • Gosling A.F.
        • O'Gara B.
        • et al.
        Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis.
        Intensive Care Med. 2022; 48: 213-224
        • Levin B.
        • Ortoleva J.
        • Tagliavia A.
        • et al.
        One-year survival for adult venoarterial extracorporeal membrane oxygenation patients requiring renal-replacement therapy.
        J Cardiothorac Vasc Anesth. 2021; https://doi.org/10.1053/j.jvca.2021.12.027
        • Thongprayoon C.
        • Cheungpasitporn W.
        • Lertjitbanjong P.
        • et al.
        Incidence and impact of acute kidney injury in patients receiving extracorporeal membrane oxygenation: a meta-analysis.
        J Clin Med. 2019; 8https://doi.org/10.3390/jcm8070981
        • St-Arnaud C.
        • Thériault M.M.
        • Mayette M.
        North-south syndrome in veno-arterial extra-corporeal membrane oxygenator: the other Harlequin syndrome.
        Can J Anaesth. 2020; 67: 262-263
        • Falk L.
        • Sallisalmi M.
        • Lindholm J.A.
        • et al.
        Differential hypoxemia during venoarterial extracorporeal membrane oxygenation.
        Perfusion. 2019; 34: 22-29
        • Choi J.H.
        • Kim S.W.
        • Kim Y.U.
        • et al.
        Application of veno-arterial-venous extracorporeal membrane oxygenation in differential hypoxia.
        Multidiscip Respir Med. 2014; 9: 55
        • Hayanga J.W.
        • D'Cunha J.
        The surgical technique of bilateral sequential lung transplantation.
        J Thorac Dis. 2014; 6: 1063-1069
        • Weingarten N.
        • Schraufnagel D.
        • Plitt G.
        • et al.
        Comparison of mechanical cardiopulmonary support strategies during lung transplantation.
        Expert Rev Med Devices. 2020; 17: 1075-1093
        • Natalini J.G.
        • Diamond J.M.
        Primary graft dysfunction.
        Semin Respir Crit Care Med. 2021; 42: 368-379
        • Ortoleva J.
        • Shapeton A.
        • Vanneman M.
        • et al.
        Vasoplegia during cardiopulmonary bypass: current literature and rescue therapy options.
        J Cardiothorac Vasc Anesth. 2020; 34: 2766-2775
        • Beer A.
        • Reed R.M.
        • Bölükbas S.
        • et al.
        Mechanical ventilation after lung transplantation. An international survey of practices and preferences.
        Ann Am Thorac Soc. 2014; 11: 546-553
        • Fan E.
        • Del Sorbo L.
        • Goligher E.C.
        • et al.
        An official American thoracic society/European society of intensive care medicine/society of critical care medicine clinical practice guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome.
        Am J Respir Crit Care Med. 2017; 195: 1253-1263
        • Laghi F.
        • Goyal A.
        Auto-PEEP in respiratory failure.
        Minerva Anestesiol. 2012; 78: 201-221
        • Ahya V.N.
        • Kawut S.M.
        Noninfectious pulmonary complications after lung transplantation.
        Clin Chest Med. 2005; 26 (vi): 613-622
        • Popple C.
        • Higgins T.L.
        • McCarthy P.
        • et al.
        Unilateral auto-PEEP in the recipient of a single lung transplant.
        Chest. 1993; 103: 297-299
        • Gavazzeni V.
        • Iapichino G.
        • Mascheroni D.
        • et al.
        Prolonged independent lung respiratory treatment after single lung transplantation in pulmonary emphysema.
        Chest. 1993; 103: 96-100
        • Anglès R.
        • Tenorio L.
        • Roman A.
        • et al.
        Lung transplantation for emphysema. Lung hyperinflation: incidence and outcome.
        Transpl Int. 2005; 17: 810-814
        • Verleden G.M.
        • Glanville A.R.
        • Lease E.D.
        • et al.
        Chronic lung allograft dysfunction: definition, diagnostic criteria, and approaches to treatment-A consensus report from the Pulmonary Council of the ISHLT.
        J Heart Lung Transplant. 2019; 38: 493-503
        • Hernández G.
        • Vaquero C.
        • González P.
        • et al.
        Effect of postextubation high-flow nasal cannula vs conventional oxygen therapy on reintubation in low-risk patients: a randomized clinical trial.
        JAMA. 2016; 315: 1354-1361
        • Esguerra-Gonzales A.
        • Ilagan-Honorio M.
        • Kehoe P.
        • et al.
        Effect of high-frequency chest wall oscillation versus chest physiotherapy on lung function after lung transplant.
        Appl Nurs Res. 2014; 27: 59-66
        • Okamoto K.
        • Santos C.A.Q.
        Management and prophylaxis of bacterial and mycobacterial infections among lung transplant recipients.
        Ann Transl Med. 2020; 8: 413
        • Kotton C.N.
        • Kumar D.
        • Caliendo A.M.
        • et al.
        The third international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation.
        Transplantation. 2018; 102: 900-931
        • Husain S.
        • Camargo J.F.
        Invasive aspergillosis in solid-organ transplant recipients: guidelines from the American society of transplantation infectious diseases community of practice.
        Clin Transplant. 2019; 33: e13544
        • Lewis T.C.
        • Sureau K.
        • Katz A.
        • et al.
        Multimodal opioid-sparing pain management after lung transplantation and the impact of liposomal bupivacaine intercostal nerve block.
        Clin Transplant. 2022; 36: e14512
        • Yasin J.
        • Thimmappa N.
        • Kaifi J.T.
        • et al.
        CT-guided cryoablation for post-thoracotomy pain syndrome: a retrospective analysis.
        Diagn Interv Radiol. 2020; 26: 53-57
        • McLean S.R.
        • von Homeyer P.
        • Cheng A.
        • et al.
        Assessing the benefits of preoperative thoracic epidural placement for lung transplantation.
        J Cardiothorac Vasc Anesth. 2018; 32: 2654-2661
        • Hutchins J.
        • Apostolidou I.
        • Shumway S.
        • et al.
        Paravertebral catheter use for postoperative pain control in patients after lung transplant surgery: a prospective observational study.
        J Cardiothorac Vasc Anesth. 2017; 31: 142-146
        • Murray A.W.
        • Boisen M.L.
        • Fritz A.
        • et al.
        Anesthetic considerations in lung transplantation: past, present and future.
        J Thorac Dis. 2021; 13: 6550-6563
        • Hachem R.R.
        • Edwards L.B.
        • Yusen R.D.
        • et al.
        The impact of induction on survival after lung transplantation: an analysis of the International Society for Heart and Lung Transplantation Registry.
        Clin Transplant. 2008; 22: 603-608
        • Levine S.M.
        A survey of clinical practice of lung transplantation in North America.
        Chest. 2004; 125: 1224-1238
        • Shah R.J.
        • Diamond J.M.
        Primary graft dysfunction (PGD) following lung transplantation.
        Semin Respir Crit Care Med. 2018; 39: 148-154
        • Schnickel G.T.
        • Ross D.J.
        • Beygui R.
        • et al.
        Modified reperfusion in clinical lung transplantation: the results of 100 consecutive cases.
        J Thorac Cardiovasc Surg. 2006; 131: 218-223
        • Christie J.D.
        • Carby M.
        • Bag R.
        • et al.
        Report of the ISHLT working Group on primary lung graft dysfunction, part II: definition — a consensus statement of the international society for heart and lung transplantation.
        J Heart Lung Transplant. 2005; 24: 1454-1459
        • Rice T.W.
        • Wheeler A.P.
        • Bernard G.R.
        • et al.
        Comparison of the SpO2/FIO2 ratio and the PaO2/FIO2 ratio in patients with acute lung injury or ARDS.
        Chest. 2007; 132: 410-417
        • Snell G.I.
        • Yusen R.D.
        • Weill D.
        • et al.
        Report of the ISHLT working Group on primary lung graft dysfunction, part I: definition and grading-A 2016 consensus Group statement of the international society for heart and lung transplantation.
        J Heart Lung Transpl. 2017; 36: 1097-1103
        • Diamond J.M.
        • Lee J.C.
        • Kawut S.M.
        • et al.
        Clinical risk factors for primary graft dysfunction after lung transplantation.
        Am J Respir Crit Care Med. 2013; 187: 527-534
        • Daud S.A.
        • Yusen R.D.
        • Meyers B.F.
        • et al.
        Impact of immediate primary lung allograft dysfunction on bronchiolitis obliterans syndrome.
        Am J Respir Crit Care Med. 2007; 175: 507-513
        • Fisher A.J.
        • Wardle J.
        • Dark J.H.
        • et al.
        Non-immune acute graft injury after lung transplantation and the risk of subsequent bronchiolitis obliterans syndrome (BOS).
        J Heart Lung Transplant. 2002; 21: 1206-1212
        • Whitson B.A.
        • Prekker M.E.
        • Herrington C.S.
        • et al.
        Primary graft dysfunction and long-term pulmonary function after lung transplantation.
        J Heart Lung Transplant. 2007; 26: 1004-1011
        • Diamond J.M.
        • Arcasoy S.
        • Kennedy C.C.
        • et al.
        Report of the international society for heart and lung transplantation working Group on primary lung graft dysfunction, part II: epidemiology, risk factors, and outcomes-A 2016 consensus Group statement of the international society for heart and lung transplantation.
        J Heart Lung Transplant. 2017; 36: 1104-1113
        • Christie J.D.
        • Bellamy S.
        • Ware L.B.
        • et al.
        Construct validity of the definition of primary graft dysfunction after lung transplantation.
        J Heart Lung Transplant. 2010; 29: 1231-1239
        • Porteous M.K.
        • Ky B.
        • Kirkpatrick J.N.
        • et al.
        Diastolic dysfunction increases the risk of primary graft dysfunction after lung transplant.
        Am J Respir Crit Care Med. 2016; 193: 1392-1400
        • Porteous M.K.
        • Lee J.C.
        • Lederer D.J.
        • et al.
        Clinical risk factors and prognostic model for primary graft dysfunction after lung transplantation in patients with pulmonary hypertension.
        Ann Am Thorac Soc. 2017; 14: 1514-1522
        • de Perrot M.
        • Bonser R.S.
        • Dark J.
        • et al.
        Report of the ISHLT working Group on primary lung graft dysfunction part III: donor-related risk factors and markers.
        J Heart Lung Transplant. 2005; 24: 1460-1467
        • Borders C.F.
        • Suzuki Y.
        • Lasky J.
        • et al.
        Massive donor transfusion potentially increases recipient mortality after lung transplantation.
        J Thorac Cardiovasc Surg. 2017; 153: 1197-1203.e2
        • Pelaez A.
        • Mitchell P.O.
        • Shah N.S.
        • et al.
        The role of donor chronic alcohol abuse in the development of primary graft dysfunction in lung transplant recipients.
        Am J Med Sci. 2015; 349: 117-123
        • Currey J.
        • Pilcher D.V.
        • Davies A.
        • et al.
        Implementation of a management guideline aimed at minimizing the severity of primary graft dysfunction after lung transplant.
        J Thorac Cardiovasc Surg. 2010; 139: 154-161
        • Meade M.O.
        • Granton J.T.
        • Matte-Martyn A.
        • et al.
        A randomized trial of inhaled nitric oxide to prevent ischemia-reperfusion injury after lung transplantation.
        Am J Respir Crit Care Med. 2003; 167: 1483-1489
        • Date H.
        • Triantafillou A.N.
        • Trulock E.P.
        • et al.
        Inhaled nitric oxide reduces human lung allograft dysfunction.
        J Thorac Cardiovasc Surg. 1996; 111: 913-919
        • Adatia I.
        • Lillehei C.
        • Arnold J.H.
        • et al.
        Inhaled nitric oxide in the treatment of postoperative graft dysfunction after lung transplantation.
        Ann Thorac Surg. 1994; 57: 1311-1318
        • Macdonald P.
        • Mundy J.
        • Rogers P.
        • et al.
        Successful treatment of life-threatening acute reperfusion injury after lung transplantation with inhaled nitric oxide.
        J Thorac Cardiovasc Surg. 1995; 110: 861-863
        • Wigfield C.H.
        • Lindsey J.D.
        • Steffens T.G.
        • et al.
        Early institution of extracorporeal membrane oxygenation for primary graft dysfunction after lung transplantation improves outcome.
        J Heart Lung Transplant. 2007; 26: 331-338
        • Fischer S.
        • Bohn D.
        • Rycus P.
        • et al.
        Extracorporeal membrane oxygenation for primary graft dysfunction after lung transplantation: analysis of the Extracorporeal Life Support Organization (ELSO) registry.
        J Heart Lung Transplant. 2007; 26: 472-477
        • Bermudez C.A.
        • Adusumilli P.S.
        • McCurry K.R.
        • et al.
        Extracorporeal membrane oxygenation for primary graft dysfunction after lung transplantation: long-term survival.
        Ann Thorac Surg. 2009; 87: 854-860
        • Kawut S.M.
        • Lederer D.J.
        • Keshavjee S.
        • et al.
        Outcomes after lung retransplantation in the modern era.
        Am J Respir Crit Care Med. 2008; 177: 114-120
        • Machuzak M.
        • Santacruz J.F.
        • Gildea T.
        • et al.
        Airway complications after lung transplantation.
        Thorac Surg Clin. 2015; 25: 55-75
        • Crespo M.M.
        • McCarthy D.P.
        • Hopkins P.M.
        • et al.
        ISHLT Consensus Statement on adult and pediatric airway complications after lung transplantation: Definitions, grading system, and therapeutics.
        J Heart Lung Transplant. 2018; 37: 548-563
        • Santacruz J.F.
        • Mehta A.C.
        Airway complications and management after lung transplantation: ischemia, dehiscence, and stenosis.
        Proc Am Thorac Soc. 2009; 6: 79-93
        • Levine D.J.
        • Glanville A.R.
        • Aboyoun C.
        • et al.
        Antibody-mediated rejection of the lung: a consensus report of the international society for heart and lung transplantation.
        J Heart Lung Transplant. 2016; 35: 397-406
        • Witt C.A.
        • Gaut J.P.
        • Yusen R.D.
        • et al.
        Acute antibody-mediated rejection after lung transplantation.
        J Heart Lung Transplant. 2013; 32: 1034-1040
        • Stewart S.
        • Fishbein M.C.
        • Snell G.I.
        • et al.
        Revision of the 1996 working formulation for the standardization of nomenclature in the diagnosis of lung rejection.
        J Heart Lung Transplant. 2007; 26: 1229-1242
        • Martinu T.
        • Howell D.N.
        • Palmer S.M.
        Acute cellular rejection and humoral sensitization in lung transplant recipients.
        Semin Respir Crit Care Med. 2010; 31: 179-188
        • Oechslin P.
        • Zalunardo M.P.
        • Inci I.
        • et al.
        Established and potential predictors of blood loss during lung transplant surgery.
        J Thorac Dis. 2018; 10: 3845-3848
        • Siddique A.
        • Bose A.K.
        • Özalp F.
        • et al.
        Vascular anastomotic complications in lung transplantation: a single institution's experience.
        Interact Cardiovasc Thorac Surg. 2013; 17: 625-631
        • Fishman J.A.
        Infection in solid-organ transplant recipients.
        N Engl J Med. 2007; 357: 2601-2614
        • Lease E.D.
        • Zaas D.W.
        Complex bacterial infections pre- and posttransplant.
        Semin Respir Crit Care Med. 2010; 31: 234-242
        • Burguete S.R.
        • Maselli D.J.
        • Fernandez J.F.
        • et al.
        Lung transplant infection.
        Respirology. 2013; 18: 22-38
        • Remund K.F.
        • Best M.
        • Egan J.J.
        Infections relevant to lung transplantation.
        Proc Am Thorac Soc. 2009; 6: 94-100
        • Zamora M.R.
        • Davis R.D.
        • Leonard C.
        Management of cytomegalovirus infection in lung transplant recipients: evidence-based recommendations.
        Transplantation. 2005; 80: 157-163
        • Kumar D.
        • Erdman D.
        • Keshavjee S.
        • et al.
        Clinical impact of community-acquired respiratory viruses on bronchiolitis obliterans after lung transplant.
        Am J Transplant. 2005; 5: 2031-2036
        • Hosseini-Moghaddam S.M.
        • Husain S.
        Fungi and molds following lung transplantation.
        Semin Respir Crit Care Med. 2010; 31: 222-233
        • Solé A.
        • Salavert M.
        Fungal infections after lung transplantation.
        Curr Opin Pulm Med. 2009; 15: 243-253
        • Ferdinande P.
        • Bruyninckx F.
        • Van Raemdonck D.
        • et al.
        Phrenic nerve dysfunction after heart-lung and lung transplantation.
        J Heart Lung Transplant. 2004; 23: 105-109
        • Lyu D.M.
        • Zamora M.R.
        Medical complications of lung transplantation.
        Proc Am Thorac Soc. 2009; 6: 101-107
        • Roukoz H.
        • Benditt D.G.
        Atrial arrhythmias after lung transplantation.
        Trends Cardiovasc Med. 2018; 28: 53-61
        • Orrego C.M.
        • Cordero-Reyes A.M.
        • Estep J.D.
        • et al.
        Atrial arrhythmias after lung transplant: underlying mechanisms, risk factors, and prognosis.
        J Heart Lung Transplant. 2014; 33: 734-740
        • Raghavan D.
        • Gao A.
        • Ahn C.
        • et al.
        Contemporary analysis of incidence of post-operative atrial fibrillation, its predictors, and association with clinical outcomes in lung transplantation.
        J Heart Lung Transplant. 2015; 34: 563-570
        • Leger R.F.
        • Silverman M.S.
        • Hauck E.S.
        • et al.
        Hyperammonemia post lung transplantation: a review.
        Clin Med Insights Circ Respir Pulm Med. 2020; 14 (1179548420966234)
        • Krutsinger D.
        • Pezzulo A.
        • Blevins A.E.
        • et al.
        Idiopathic hyperammonemia after solid organ transplantation: primarily a lung problem? A single-center experience and systematic review.
        Clin Transplant. 2017; 31https://doi.org/10.1111/ctr.12957
        • Scientific Registry of Transplant Recipients
        Patient survival after lung transplantation.
        (Available at:) (Accessed December 14, 2015)
        • Cohen J.
        • Singer P.
        • Raviv Y.
        • et al.
        Outcome of lung transplant recipients requiring readmission to the intensive care unit.
        J Heart Lung Transplant. 2011; 30: 54-58
        • Banga A.
        • Sahoo D.
        • Lane C.R.
        • et al.
        Characteristics and outcomes of patients with lung transplantation requiring admission to the medical ICU.
        Chest. 2014; 146: 590-599
        • Hadjiliadis D.
        • Steele M.P.
        • Govert J.A.
        • et al.
        Outcome of lung transplant patients admitted to the medical ICU.
        Chest. 2004; 125: 1040-1045
        • Lee J.C.
        • Christie J.D.
        Primary graft dysfunction.
        Clin Chest Med. 2011; 32: 279-293
        • Porteous M.K.
        • Lee J.C.
        Primary graft dysfunction after lung transplantation.
        Clin Chest Med. 2017; 38: 641-654