Lung Transplantation: New Trends

*Perioperative Care for Organ Transplant Recipient*

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2014;**98**(8):857-863

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**Chapter 5**

**Abstract**

**1. Introduction**

Perioperative Care for Lung

Multidisciplinary Approach

*Stacey H. Brann, Steven S. Geier, Olga Timofeeva,* 

*Norihisa Shigemura, Francis Cordova and Yoshiya Toyoda*

Lung transplantation has evolved as the gold standard for selective patients with end-stage lung disease since the first clinical lung transplant was performed in 1983 in the United States. Over the last few decades, lung transplantation volume has increased worldwide with steadily improving outcomes; however, access to lung transplantation remains limited due to the critical shortage of donor organs. Factors that have contributed to improved outcomes include a multidisciplinary management approach supported by advancements in surgical and anesthetic techniques, nursing and critical care, immunosuppressive therapy, transplant immunobiology, and the perioperative use of extracorporeal membrane oxygenation (ECMO) and ex vivo lung perfusion (EVLP). Excellent outcomes have been achieved in selective patients with high-risk comorbidities such as age over 65 years, concomitant severe coronary artery disease (CAD), and preexisting sensitization with donor-specific antibodies (DSAs). Such comorbidities are no longer considered absolute contraindications to lung transplantation. This chapter provides an overview of perioperative care of lung transplant recipients with focus on a multidisciplinary approach and highlights management strategies for patients with concomitant severe coronary artery disease and end-stage lung disease as well as those with preexisting sensitization with DSAs.

**Keywords:** perioperative care, lung transplantation, multidisciplinary management

Lung transplantation has evolved as the gold standard for select patients with endstage lung disease since the first clinical lung transplant was performed in 1983 in the United States. Over the last few decades, worldwide lung transplantation volume has steadily increased to approximately 4000 cases annually with progressive improvements in long-term survival. Perioperative management of lung transplant recipients is a highly complex endeavor. Crucial components include mechanical ventilation and weaning strategies, fluid management, and immunosuppression including induction therapy, management of rejection, perioperative antibiotics, antimicrobial prophylaxis, chest tube management, nutritional support, discharge planning, and education. Optimal early outcomes are dependent on a well-coordinated, multidisciplinary approach. Factors that have contributed to improved outcomes include advancements in perioperative critical care, surgical and anesthetic techniques, improved

Transplant Recipients: A
