Caring for Heart and Lung Transplant Patients

Heart and lung transplantation are the definitive, and often the only, therapeutic option for patients with end stage cardiac or respiratory failure. Their journey through the intensive care unit often begins before the transplant operation when the global shortage of suitable donor organs makes bridging with mechanical circulatory support necessary. Once transplanted, recipients are vulnerable to a large number of complications ranging from issues arising from the operation to secondary organ failure and infection and to primary graft failure. Clinicians managing these patients need to be able to recognize these issues early and they need to have the tools to initiate treatment in a timely manner. There is no such discipline as a cardiothoracic transplant intensivist. Managing these complex patients requires a highly skilled team of individuals from different backgrounds - intensivists, surgeons, cardiologists and chest physicians as well as nurses, physiotherapists, ECMO specialists, pharmacists, dieticians and many more. They all contribute vital knowledge and skills. In order to put these to good use, however, they need to share the willingness and ability to efficiently communicate with each other. This review aims to give the general intensivist an overview over the peri-operative care of heart and lung transplant patients while also providing general principles should these patients need treatment outside a specialist intensive care unit.