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.

Liver transplantation (LT) is the accepted treatment for a wide variety of liver diseases in children. Some children develop hepatorenal or hepatopulmonary syndrome, which often reverses after LT. Acute liver failure (ALF) is rare in children, but is associated with significant mortality. Donor liver grafts for children are most commonly obtained from donation after brain death (DBD) donors. Split LT provides two grafts from a single donor, the left lateral segment for a child and the right lobe for an adult. Tacrolimus (TAC) is now the preferred agent for maintenance immunosuppression in pediatric LT. Immunosuppression generally requires the use of steroids, which are rapidly weaned or withdrawn in the majority of children. Common causes for retransplantation are hepatic artery thrombosis (HAT), primary graft dysfunction (PGD), chronic rejection and biliary complications. Health-related quality of life (HRQOL) assesses markers of overall well-being and functional outcomes, including physical, psychological, and social functions.

Thoracic epidural analgesia should be considered in all cases, but may be most safely sited postoperatively. In addition to the usual anesthetic issues of aspiration risk, airway assessment, comorbidities, medications, and adverse reactions, assessment on the day of surgery focuses on the current illness state and amount of deterioration since investigations were performed, as the patient's physical state may be significantly worse than investigations may suggest. Mandatory monitoring includes five-lead electrocardiography, pulse goniometry, invasive measurement of arterial, central venous, and pulmonary artery (PA) pressures; urine output via an indwelling catheter, temperature, oceanography, pyrometer and anesthetic agent gas analysis. Maintenance of anesthesia by protocol infusion, inhalational anesthetic agent, or both has been described. Most patients with end-stage parenchyma lung disease can get symptomatic improvement with single lung transplantation (SLT). Primary graft dysfunction (PGD) is a devastating complication akin to acute lung injury due to the transplantation process.