Skip to main navigation menu Skip to main content Skip to site footer

Review article: Biomedical intelligence

Vol. 143 No. 1516 (2013)

Practical approach to early postoperative management of lung transplant recipients

  • Macé M. Schuurmans
  • Christian Benden
  • Ilhan Inci
Cite this as:
Swiss Med Wkly. 2013;143:w13773


Meticulous attention to detail during the early postoperative period after lung transplantation is crucial for the overall success of the procedure. It starts in the intensive care unit with the initiation of immunosuppression, implementation of anti-infective strategies and stabilisation of respiratory function. The subsequent days and weeks on the regular ward focus on titration of immunosuppressive drugs, vigilant fluid management, early mobilisation and initiation of physiotherapy. In parallel, the lung transplant recipients are actively taught about self-monitoring and self-management strategies to allow for a smooth transition to outpatient follow-up care. This article intends to communicate the practical aspects and principles of the patient management used at the authors’ centre on a daily basis by a multi-disciplinary transplant team, having at its core both a transplant pulmonologist and a thoracic surgeon. It focuses on the first month after lung transplantation, but does not cover surgical techniques, rare complications or long-term management issues of lung transplant recipients. The target audience of this practical guide are advanced trainees of pulmonology, thoracic surgery, intensive care, anaesthesiology and other clinicians involved in the early postoperative care of lung transplant recipients either in the intensive care unit or on the peripheral ward.


  1. Bhorade S. Lung Transplant Considerations for the Community Pulmonologist. ACCP Transplant Network, Chest. 2007(072407):1–63.
  2. Dumonceaux M, Knoop C, Rondelet B, Estenne M. Complications of lung transplantation: perioperative complications, acute and chronic rejection. Rev Mal Respir. 2009;26(6):639–53.
  3. Knoop C, Rondelet B, Dumonceaux M, Estenne M. Medical complications of lung transplantation. Rev Pneumol Clin. 2010;67(1):28–49.
  4. Hays S, Lee J, Boettger R, Golden J, Hoopes C. Lung Transplant Manual. University of California, San Francisco Medical Center. 2005.
  5. Levine SM. A survey of clinical practice of lung transplantation in North America. Chest. 2004;125(4):1224–38.
  6. University of Michigan. Heart and Lung Transplant Guidelines. 2006.
  7. Masclans JR, Vicente R, Ballesteros MA, Sabater J, Roca O, Rello J. Solid organ transplant training objectives for residents. Med Intensiva. 2012;36(8):584-8.
  8. Speich R, Nicod LP, Aubert JD, Spiliopoulos A, Wellinger J, Robert JH, et al. Ten years of lung transplantation in Switzerland: results of the Swiss Lung Transplant Registry. Swiss Med Wkly. 2004;134(1-2):18–23.
  9. Inci I, Weder W. Managing surgical complications. Lung Biology in Health and Disease. 2011;243:249–65.
  10. Fuehner T, Greer M, Welte T, Gottlieb J. The lung transplant patient in the ICU. Curr Opin Crit Care. 2012;18(5):472–8.
  11. Rello J. Lung transplant: An emerging challenge in the ICU. Med Intensiva. 2012;36(7):504–5.
  12. Korom S, Boehler A, Weder W. Immunosuppressive therapy in lung transplantation: state of the art. Eur J Cardiothorac Surg. 2009;35(6):1045–55.
  13. Krueger T, Berutto C, Aubert JD. Challenges in lung transplantation. Swiss Med Wkly. 2011;141:w13292.
  14. Maes BD, Vanrenterghem YF. Cyclosporine: advantages versus disadvantages vis-a-vis tacrolimus. Transplant Proc. 2004;36(2 Suppl):40S–9S.
  15. Treede H, Glanville AR, Klepetko W, Aboyoun C, Vettorazzi E, Lama R, et al. Tacrolimus and cyclosporine have differential effects on the risk of development of bronchiolitis obliterans syndrome: results of a prospective, randomized international trial in lung transplantation. J Heart Lung Transplant. 2012;31(8):797–804.
  16. Kumar V, Gaston SG. Immunosuppression: past, present, and future. In: Klein AA, Lewis, C.J., Madsen, J.C., editor. Organ transplantation: a clinical guide: Cambridge University Press; 2011. p. 19–30.
  17. Weder W, Inci I, Korom S, Kestenholz PB, Hillinger S, Eich C, et al. Airway complications after lung transplantation: risk factors, prevention and outcome. Eur J Cardiothorac Surg. 2009;35(2):293–8; discussion 8.
  18. Schuurmans MM, Tini GM, Zuercher A, Hofer M, Benden C, Boehler A. Practical approach to emergencies in lung transplant recipients: how we do it. Respiration. 2012;84(2):163–75.
  19. Speich R, van der Bij W. Epidemiology and management of infections after lung transplantation. Clin Infect Dis. 2001;33(Suppl 1):S58–65.
  20. Remund KF, Best M, Egan JJ. Infections relevant to lung transplantation. Proc Am Thorac Soc. 2009;6(1):94–100.
  21. Ledson MJ, Gallagher MJ, Robinson M, Cowperthwaite C, Williets T, Hart CA, et al. A randomized double-blinded placebo-controlled crossover trial of nebulized taurolidine in adult cystic fibrosis patients infected with Burkholderia cepacia. J Aerosol Med. 2002;15(1):51–7.
  22. Boehler A. Update on cystic fibrosis: selected aspects related to lung transplantation. Swiss Med Wkly. 2003;133(7–8):111–7.
  23. Vital D, Hofer M, Boehler A, Holzmann D. Posttransplant sinus surgery in lung transplant recipients with cystic fibrosis: a single institutional experience. Eur Arch Otorhinolaryngol. 2012.
  24. Neoh CF, Snell GI, Kotsimbos T, Levvey B, Morrissey CO, Slavin MA, et al. Antifungal prophylaxis in lung transplantation – a world-wide survey. Am J Transplant. 2011;11(2):361–6.
  25. Borro JM, Sole A, de la Torre M, Pastor A, Fernandez R, Saura A, et al. Efficiency and safety of inhaled amphotericin B lipid complex (Abelcet) in the prophylaxis of invasive fungal infections following lung transplantation. Transplant Proc. 2008;40(9):3090–3.
  26. Kim JY, Zaoutis TE. Multidrug-resistant bacteria in cardiothoracic transplantation and mechanical circulatory support: gram positive. In: Mooney ML, Hannan MM, Husain S, Kirklin JK, editors. Diagnosis and management of infectious diseases in cardiothoracic transplantation and mechanical circulatory support: Elsevier; 2011. p. 143–50.
  27. Kotton CN, Kumar D, Caliendo AM, Asberg A, Chou S, Snydman DR, et al. International consensus guidelines on the management of cytomegalovirus in solid organ transplantation. Transplantation. 2010;89(7):779–95.
  28. Allen UD, Verschuuren EAM, Green MD. Epstein-barr virus in cardiothoracic transplantation. In: Mooney ML, Hannan MM, Husain S, Kirklin JK, editors. Diagnosis and management of infectious diseases in cardiothoracic transplantation and mechanical circulatory support: Elsevier; 2011. p. 238–44.
  29. Manuel O, Danziger-Isakov L. Other herpes viruses in cardiothoracic transplantation. In: Mooney ML, Hannan MM, Husain S, Kirklin JK, editors. Diagnosis and management of infectious diseases in cardiothoracic transplantation and mechanical circulatory support: Elsevier; 2011. p. 245–56.
  30. Timrott K, Vondran FW, Jaeger MD, Gottlieb J, Klempnauer J, Becker T. Incidence and outcome of abdominal surgical interventions following lung transplantation – a single center experience. Langenbecks Arch Surg. 2011;396(8):1231–7.
  31. Lahon B, Mordant P, Thabut G, Georger JF, Dauriat G, Mal H, et al. Early severe digestive complications after lung transplantation. Eur J Cardiothorac Surg. 2011;40(6):1419–24.
  32. Wickerson L, Mathur S, Brooks D. Exercise training after lung transplantation: a systematic review. J Heart Lung Transplant. 2010;29(5):497–503.
  33. Kaltenbach T, Crockett S, Gerson LB. Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med. 2006;166(9):965–71.
  34. Castor JM, Wood RK, Muir AJ, Palmer SM, Shimpi RA. Gastroesophageal reflux and altered motility in lung transplant rejection. Neurogastroenterol Motil. 2010;22(8):841–50.
  35. Toivonen HJ. Anaesthesia for patients with a transplanted organ. Acta Anaesthesiol Scand. 2000;44(7):812–33.
  36. Suberviola B, Castellanos-Ortega A, Ballesteros MA, Zurbano F, Naranjo S, Minambres E. Early identification of infectious complications in lung transplant recipients using procalcitonin. Transpl Infect Dis. 2012;14(5):461–7.
  37. Kuypers DR, Le Meur Y, Cantarovich M, Tredger MJ, Tett SE, Cattaneo D, et al. Consensus report on therapeutic drug monitoring of mycophenolic acid in solid organ transplantation. Clin J Am Soc Nephrol. 2010;5(2):341–58.
  38. Hochhegger B, Irion KL, Marchiori E, Bello R, Moreira J, Camargo JJ. Computed tomography findings of postoperative complications in lung transplantation. J Bras Pneumol. 2009;35(3):266–74.
  39. Krishnam MS, Suh RD, Tomasian A, Goldin JG, Lai C, Brown K, et al. Postoperative complications of lung transplantation: radiologic findings along a time continuum. Radiographics. 2007;27(4):957–74.
  40. Fuehner T, Welte T, Simon A, Gottlieb J. Complications after lung transplantation. Part 1: Intensive medical and pneumologic complications. Dtsch Med Wochenschr. 2008;133(15):782–6.
  41. Knoop C, Dumonceaux M, Rondelet B, Estenne M. Complications of lung transplantation. Rev Mal Respir. 2010;27(4):365–82.
  42. Vinarsky V, Ginns LC. Postoperative care and early complications. In: Klein AA, Lewis, C.J., Madsen, J.C., editor. Organ transplantation: a clinical guide: Cambridge University Press; 2011. p. 145–54.
  43. Ip D, Slinger P. Management during surgery. In: Klein AA, Lewis, C.J., Madsen, J.C., editor. Organ transplantation: a clinical guide: Cambridge University Press; 2011. p. 138–
  44. Watkins RR, Lemonovich TL. Evaluation of infections in the lung transplant patient. Curr Opin Infect Dis. 2012;25(2):193–8.
  45. Al-Hasan MN, Razonable RR, Eckel-Passow JE, Baddour LM. Incidence rate and outcome of Gram-negative bloodstream infection in solid organ transplant recipients. Am J Transplant. 2009;9(4):835–43.
  46. Dunning J, Treasure T, Versteegh M, Nashef SA. Guidelines on the prevention and management of de novo atrial fibrillation after cardiac and thoracic surgery. Eur J Cardiothorac Surg. 2006;30(6):852–72.
  47. Kugler C, Fuehner T, Dierich M, DeWall C, Haverich A, Simon A, et al. Effect of adherence to home spirometry on bronchiolitis obliterans and graft survival after lung transplantation. Transplantation. 2009;88(1):129–34.
  48. Glanville AR. Bronchoscopic monitoring after lung transplantation. Semin Respir Crit Care Med. 2010;31(2):208–21.
  49. Toronto. Lung Transplant Patient Manual. 2010.

Most read articles by the same author(s)

1 2 > >>