Anesthesia for lung transplantation: A narrative review

Area of Science:

• Cardiology
• Pulmonology
• Anesthesiology

Background:

• Lung transplantation is the definitive treatment for end-stage lung disease, with indications including severe chronic obstructive pulmonary disease (COPD), interstitial lung disease, cystic fibrosis, and pulmonary hypertension.
• The procedure can involve single, bilateral sequential, or combined heart-lung transplantation, depending on the specific lung condition and associated cardiac status.

Purpose of the Study:

• To highlight the critical role of anesthesiologists in all phases of lung transplantation, from recipient assessment and perioperative management to postoperative care.
• To share institutional experience with bilateral sequential lung transplants and discuss the complexities and high-risk nature of the procedure.

Main Methods:

• Review of institutional experience with 15 bilateral sequential lung transplants.
• Discussion of the anesthesiologist's responsibilities, including recipient evaluation, extracorporeal life support (ECLS) management, intraoperative anesthetic care, hemodynamic monitoring, and postoperative management.
• Emphasis on managing complex perioperative protocols and potential complications.

Main Results:

• Lung transplantation is a high-risk procedure associated with significant perioperative morbidity and mortality.
• Anesthesiologists are integral to the multidisciplinary team, managing critical aspects like anticoagulation, cardiopulmonary bypass, and extracorporeal membrane oxygenation (ECMO).
• Intraoperative pulmonary artery pressures exceeding 100 mmHg were observed in many patients, underscoring the hemodynamic challenges.

Conclusions:

• Lung transplantation, while curative, demands meticulous perioperative management and a skilled anesthesiology team.
• The complexity of lung transplantation necessitates specialized centers and standardized protocols, potentially benefiting from shared experiences.
• Further development and dissemination of lung transplantation programs are encouraged, with this article serving as a resource for protocol formulation.