Lung transplantation: from the procedure to managing patients with lung transplantation

The perioperative management of lung transplantation patients remains a challenge. The most important goal is the prevention or attenuation of primary graft failure due to ischemia and reperfusion, operative trauma, and activation of systemic inflammation; it significantly influences short-long and long-term outcome. This review focuses on different aspects regarding the management of these high-risk patients.

The Lung Allocation Score was implemented to estimate the survival benefit from a lung transplant. As scarcity of lung grafts persists new techniques such as the ex-vivo lung perfusion might allow for expanding the criteria and distribution range of donor organs. Thoracic anesthesia for lung transplantation faces the challenge to manage impaired oxygenation, refractory hypercapnia, and severe pulmonary hypertension in order to attenuate the risk of primary graft failure. Further, lung protective ventilator strategies to prevent postoperative acute lung injury might have an impact on outcome. This includes extracorporeal circulation therapy as rapid advances in this field open up new possibilities. Recent findings suggest that particular attention should be paid to neurocognitive outcome.

There is evidence that important key strategies improve outcome after lung transplantation. An update on the substantial challenges in anesthesia comprises ventilator strategy and the use of extracorporeal circulation to minimize inflammation associated with primary graft failure.