[Complications of lung transplantation]

In 2009 lung transplantation is a valuable therapeutic option for a number of patients suffering from end-stage pulmonary diseases. Lung transplantation frequently offers a major improvement in quality of life; however, long-term survival is often limited by the development of the bronchiolitis obliterans syndrome, which is the equivalent of a chronic pulmonary graft rejection. As the bronchiolitis obliterans syndrome is the commonest cause of death in the medium- and long-terms, all patients receive intense immunosuppressive treatment in order to prevent or stabilize this complication. This treatment induces a number of potentially severe complications including metabolic complications, infections and malignancies. The most frequent metabolic complications are arterial hypertension, chronic renal insufficiency, hyperlipidaemia, diabetes and osteoporosis. Bacterial, viral and fungal infections are the second commonest cause of mortality. They are to be considered as medical emergencies and require urgent assessment and targeted therapy after microbiological specimens have been obtained. They should not under any circumstances be treated empirically and it should also be kept in mind that the lung transplant recipient may present several concomitant infections. The most frequent malignancies are post-transplant lymphoproliferative disorders, cutaneous neoplasias, Kaposi's sarcoma, some peculiar types of head and neck neoplasia, bronchogenic carcinomas and cancers of the digestive tract. The respiratory physician should recognize the symptoms and signs of specific complications induced by the immunosuppressive regimen and the goal of this report is to give a general overview of the most frequently encountered complications. Their assessment and treatment, though, will most often require the input of other specialists and a multidisciplinary approach.