Chapter 18 - Postoperative care and early complications

Summary

This chapter focuses on postoperative fluid management and early complications of lung transplantation (LT). Patients with emphysema who undergo single LT (SLT) require special attention to airway pressures and the compliance difference between the allograft and the native lung. Postoperative antimicrobial coverage should be modified if pathogens are identified in the sputum of the donor that is not already covered by the recipient-specific regimen. Postoperative hemodynamic instability has been common in patients with underlying pulmonary hypertension. Maintaining optimal nutrition in the postoperative period is essential and may improve operative outcomes. Early complications of LT can be classified into four categories: complications of the surgery itself, re-implantation response and primary graft dysfunction (PGD), immunologic complications including rejection, and organ-specific complications of the immunosuppressive agents. Standard therapy is recommended in the early post-transplant setting, although a focal structural abnormality may require surgical removal if it becomes the source of recurrent infection.