Skip to main content

Advertisement

SpringerLink
Log in

Medical complications after lung transplantation

  • Lung Transplant (M Zamora, Section Editor)
  • Published:
Current Pulmonology Reports Aims and scope Submit manuscript

Abstract

In recent years, the field of lung transplantation has seen incremental advances in surgical technique and medical management, resulting in improved graft survival and an overall increase in the number of lung transplants performed worldwide. Lung transplantation is now performed in older patients with greater comorbidities and more pulmonary dysfunction prior to transplant than in past eras. Consequently, we have greater knowledge of the significant medical complications that occur after lung transplant including cardiovascular disease, renal insufficiency, gastroesophageal reflux, blood dyscrasias, neurologic disease, and malignancies. This article focuses on noninfectious, nonpulmonary medical complications seen postoperatively and discusses their impact on overall morbidity and mortality after lung transplantation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hardy JD, Webb WR, Dalton Jr ML, Walker Jr GR. Lung homotransplantation in man. JAMA. 1963;186:1065–74.

    Article  CAS  PubMed  Google Scholar 

  2. Yusen RD, Edwards LB, Kucheryavaya AY, Benden C, Dipchand A, et al. The registry of the International Society for Heart and Lung Transplantation: thirty-first adult lung and heart lung transplant report—2014; focus theme: retransplantation. J Heart Lung Transplant. 2014;33:1009–24.

    Article  PubMed  Google Scholar 

  3. Mason DP, Marsh DH, Alster JM, Murthy SC, McNeill AM, et al. Atrial fibrillation after lung transplant: timing, risk factors, and treatment. Ann Thorac Surg. 2007;84:1878–84.

    Article  PubMed  Google Scholar 

  4. Nielsen TD, Bahnson T, Davis RD, Palmer SM. Chest. 2004;126:496–500.

    Article  PubMed  Google Scholar 

  5. Dizon J, Chen K, Bacchetta M, Argenziano M, Mancini D. A comparison of atrial arrhythmias after heart or double lung transplant at a single center. J Am Coll Cardiol. 2009;54:2043–8.

    Article  PubMed  Google Scholar 

  6. Azadani PN, Kumar UN, Yang Y, Scheinman MM, Hoopes CW, et al. Frequency of atrial flutter after adult lung transplantation. Am J Cardiol. 2001;107:922–6.

    Article  Google Scholar 

  7. See VY, Roberts-Thompson KC, Stevenson WG, Camp PC, Koplan BA, et al. Circ Arrhythm Electrophysiol. 2009;2:504–10.

    Article  PubMed  Google Scholar 

  8. Lee G, Wu H, Kalman JM, Esmore D, Williams T, et al. Atrial fibrillation following lung transplantation: double but not single lung transplant is associated with long term freedom from paroxysmal atrial fibrillation. Eur Heart J. 2010;31:2774–82.

    Article  PubMed  Google Scholar 

  9. Henri C, Giraldeau G, Dorais M, Cloutier A, Girard F, et al. Atrial fibrillation after pulmonary transplantation. Incidence, impact on mortality, treatment effectiveness, and risk factors. Circ Arrhythm Electrophysiol. 2012;5:61–7. This study in post lung transplant recipients focuses on post lung transplantation atrial fibrillation including review of prevalence of atrial arrhythmias, risk factors for atrial fibrillation, and effectiveness of treatment and subsequent impact on mortality.

  10. Isiadinso I, Meshkov AB, Gaughan J, Sandu P, Lim S, et al. Atrial arrhythmias after lung and hear lung transplant: effects on short term mortality and the influence of amiodarone. J Heart Lung Transplant. 2011;30:37–44.

    Article  PubMed  Google Scholar 

  11. Castleberry AW, Martin JT, Osho AA, Hartwig MG, Hashmi ZA, et al. Coronary revascularization in lung transplant recipients. Am J Transplantation. 2013;13:2978–88. This is one of the few studies in the literature looking at coronary revascularization at the time of transplant and early outcomes with combined procedure at Duke University.

  12. Lee R, Meyers BF, Sundt TM, Turlock EP, Patterson GA. Concomitant coronary artery revascularization to allow successful lung transplantation in selected patients with coronary artery disease. J Thorac Cardiovasc Surg. 2002;124:1250–1.

    Article  PubMed  Google Scholar 

  13. Patel VS, Palmer SM, Messier RH, Davis RD. Clinical outcome after coronary artery revascularization and lung transplantation. Ann Thorac Surg. 2003;75:372–7.

    Article  PubMed  Google Scholar 

  14. Thaik CM, Semigran MJ, Ginns L, Wain JC, Dec GW. Evaluation of ischemic heart disease in potential lung transplant recipients. J Heart Lung Transplant. 1995;14:257–66.

    CAS  PubMed  Google Scholar 

  15. Zanotti G, Hartwig M, Castleberry AW, Martin JT, Shaw L, et al. Preoperative mild to moderate coronary artery disease does not affect long term outcomes of lung transplantation. Transplantation. 2014;97:107–1085. This is a single center study reviewing outcomes in pre lung transplant candidates with mild to moderate coronary artery disease and that the presence of mild to moderate CAD (with no intervention at time of transplant) does not increase the perioperative morbidity or decrease the long term survival in the patient cohort . The study also provides information some recommendations for follow-up of CAD in this population after transplant.

  16. Savioli G, Surbone S, Giovi I, Salinaro F, Preti P, et al. Early development of metabolic syndrome in patients subjected to lung transplantation. Clin Transpl. 2013;27:E237–43.

    Article  Google Scholar 

  17. Johnston BA, Iacono AT, Zeevi A, McCurry KR, Duncan SR. Statin use is associated with improved function and survival of lung allografts. Am J Respir Crit Care Med. 2003;167:1271–8.

    Article  Google Scholar 

  18. Fessler MB, Young SK, Jeyaseelan S, Leiber JG, Arndt PG, et al. A role for hydroxy-methylglutaryl coenzyme A reductase in pulmonary inflammation and host defenses. Am J Respir Crit Care Med. 2005;171:606–15.

    Article  PubMed  Google Scholar 

  19. Ishikawa S, Griesdale D, Lohser J. Acute kidney injury within 72 hours after transplantation: incidence and perioperative risk factors. J Cardiothorac Vasc Anesth. 2014;28:943–7.

    Article  CAS  PubMed  Google Scholar 

  20. Wehbe E, Duncan AE, Dar G, Budev M, Stephany B. Recovery from AK I and short and long-term outcomes after lung transplantation. Clin J Am Soc Nephrol. 2013;8:19–25. This study looks at the impact of short term and long term risks of CKD and mortality in patients that have complete recovery from AKI after lung transplantation.

  21. Fidalgo P, Ahmed M, Meyer S, Lien D, Weinkauf J, et al. Incidence and outcomes of acute kidney injury following orthotropic lung transplant: population based cohort study. Nephrol Dial Transplant. 2014;29:1702–9.

    Article  CAS  PubMed  Google Scholar 

  22. Hauck J, Osho A, Castleberry A, Hartwig M, Reddy L, et al. Acute kidney injury after ex vivo lung perfusion (EVLP). Transplant Proc. 2014;46:3598–602.

    Article  CAS  PubMed  Google Scholar 

  23. Al-Naamani N, Maarouf OH, Wilt JS, Bacchetta M, D’Ovidio F, et al. The defecation of diet and renal disease (MDRD) and the protection of kidney outcomes after lung transplantation. J Heart Lung Transplant. 2008;27:1191–7.

    Article  PubMed  Google Scholar 

  24. Quon BS, Mayer-Hamblett N, Aitken ML, Goss CH. Risk of post lung transplant renal dysfunction and adults with cystic fibrosis. Chest. 2012;142:185–91.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Kubal C, Cockwell P, Bridget G, Jesky M, Hanvesakul R, et al. Chronic kidney disease after nonrenal solid organ transplantation: a histological assessment and utility of chronic allograft damage index scoring. Transplantation. 2012;93:406–11.

    Article  PubMed  Google Scholar 

  26. Gullestad L, Iversen M, Mortensen SA, Eiskjoer H, Riise GC, Mared L, et al. Everolimus with reduced calcineurin inhibitor in thoracic transplant recipients with renal dysfunction: a multicenter, randomized trial. Transplantation. 2010;89:864–72.

    Article  CAS  PubMed  Google Scholar 

  27. Mason DP, Solovera-Rozas M, Feng J, Rajeswaran J, Thuita L, et al. Dialysis after lung transplantation: prevalence, risk factors and outcome. J Heart Lung Transplant. 2007;26:1155–62.

    Article  PubMed  Google Scholar 

  28. Arnaoutakis GJ, George TJ, Robinson CW, Gibbs KW, Orens JB, et al. Severe acute kidney injury according to the RIFLE (risk, injury, failure, loss, end-stage) criteria affects mortality in lung transplantation. J Heart Lung Transplant. 2011;30:1161–8. This study focuses on the impact of post operative renal replacement therapy and CKD on mortality after lung transplantation.

  29. Otani S, Levvey BJ, Westall GP, Paraskeva M, Whitford H, et al. Long term successful outcomes from kidney transplantation after lung and heart lung transplantation. Ann Thorac Surg. 2015;99:1032–9. This study looks at long-term outcomes after late kidney transplant as well as after lung and kidney transplant providing the readers with an insight into the challenges that are present with live deceased donor kidney transplant in the setting of lung transplant in contrast with living related kidney transplant after lung transplant.

  30. Lubetkin EI, Lipson DA, Palevsky HI, Kotloff R, Morris J, et al. GI obligations after orthotopic lung transplant. Am J Gastroenterol. 1996;91:2382–90.

    CAS  PubMed  Google Scholar 

  31. Seccombe J, Mirza F, Hachem R, Gyawali CP. Esophageal motor disease and reflux patterns in patients with advanced pulmonary disease undergoing lung transplantation. Neurogastroenterol Motil. 2013;25:657–e508.

    Article  CAS  PubMed  Google Scholar 

  32. Palmer SM, Miralles AP, Howell DN, Brazer SR, Tapson VF, et al. Gastroesophageal reflux as a reversible cause of allograft dysfunction after lung transplantation. Chest. 2000;118:1214–7.

    Article  CAS  PubMed  Google Scholar 

  33. Young LR, Hadjiliiadis D, Davis RD, Palmer SM. Lung transplantation exacerbates gastroesophageal reflux disease. Chest. 2003;124:1689–93.

    Article  PubMed  Google Scholar 

  34. Hartwig MG, Davis RD. Gastroesophageal reflux disease induced aspiration injury following lung transplantation. Curr Opin Organ Transplant. 2012;17:474–8. This is a comprehensive review of GERD and aspiration injury including basic science and brief includes review of the available literature on GER and aspiration injury.

  35. Gulack BC, Meza JM, Lin SS, Hartwig MG, Davis RD. Reflux and allograft dysfunction: is there a connection? Thorac Surg Clin. 2015;25:97–105. This manuscript provides an excellent overview of the development of BOS as a result of reflux disease.

  36. Mertens V, Blondeau K, Oudenhove LV. Bile acids aspiration reduces survival in lung transplant recipients with BOS despite azithromycin. Am J Transplant. 2011;11:329–35.

    Article  CAS  PubMed  Google Scholar 

  37. Hartwig MG, Anderson DJ, Onaitis MW, Reddy S, Snyder LD, et al. Fundoplication after lung transplantation prevents the allograft dysfunction associated with reflux. Ann Thor Surg. 2011;92:462–8.

    Article  Google Scholar 

  38. Murthy SC, Nowicki ER, Mason DP, Budev MM, Nunez A, et al. Preoperative gastroesophageal reflux impacts early outcomes after lung transplantation. J Heart Lung Transplant. 2009;28:47–52e3.

    Google Scholar 

  39. Cantu III E, Appel III JZ, Hartwig MG, Woreta H, Green C, et al. Maxwell Chamberlain memorial paper. Early adult plication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease. Ann Thorac Surg. 2004;78:1142–52.

    Article  PubMed  Google Scholar 

  40. Savarino E, Bazzica M, Zentilin P, Pohl D, Parodi A, et al. Gastroesophageals reflux and pulmonary fibrosis in scleroderma: a study using pH impedance monitoring. Am J Respir Crit Care Med. 2009;179:408–13.

    Article  PubMed  Google Scholar 

  41. De Cruz S, Ross D. Fundoplication in patients with scleroderma. Curr Opin Rheumatol. 2013;25:714–8.

    Article  PubMed  Google Scholar 

  42. Henderson RD, Pearson FG. Surgical management of esophageal scleroderma. J Thorac Cardiovasc Surg. 1973;66:686–92.

    CAS  PubMed  Google Scholar 

  43. Poirier NC, Taillefer R, Topart P, Doranceau A. Antireflux operations in patients with scleroderma. Ann Thorac Surg. 1994;58:66–72.

    Article  CAS  PubMed  Google Scholar 

  44. Kent MS, Luketich JD, Irshad K. Comparison of surgical approaches to recalcitrant gastroesophageal reflux disease in the patient with scleroderma. Ann Thorac Surg. 2007;84:1710–5.

    Article  PubMed  Google Scholar 

  45. Lidor AO, Ensor CR, Sheer AJ, Orens JB, Clarke JO, et al. Domperidone for delayed gastric emptying and lung transplant recipients with and without gastroesophageal reflux. Prog Transplant. 2014;24:27–32.

    Article  PubMed  Google Scholar 

  46. Larson ES, Khalil HA, Lin AY, Russell M, Ardehali A, et al. Diverticulitis occurs early after lung transplantation. J Surg Res. 2014;190:667–71.

    Article  PubMed  Google Scholar 

  47. Ollech JE, Kramer MR, Peled N, Ollech A, Amital A, et al. Post transplant diabetes mellitus and lung transplant recipients: incidence and risk factors. Eur J Cardiothorac Surg. 2008;33:844–8.

    Article  PubMed  Google Scholar 

  48. Bradbury RA, Shirkhedkar D, Glanville AR, Campbell LV. Prior diabetes mellitus is associated with increased morbidity and cystic fibrosis patients undergoing bilateral lung transplantation: an “orphan” area? A retrospective case control study. Intern Med J. 2009;39:384–8.

    Article  CAS  PubMed  Google Scholar 

  49. Hackman KL, Bailey MJ, Snell GI, Bach LA. Diabetes is a major risk factor for after lung transplantation. Am J Transplant. 2014;14:438–45. This study provides information about pre-, post lung transplant and diabetes and its impact long term graft dysfunction. The study also reviews potential impact that hyperglycemia may have in the development of BOS.

  50. Lyu DM, Zamora MR. Medical complications of lung transplantation. Proc Am Thorac Soc. 2009;6:101–7.

    Article  PubMed  Google Scholar 

  51. Kulak CA, Cochenski Borba VZ, Kulak J, Ribeiro Custodio M. Osteoporosis after solid organ transplant. Minerva Endocrinol. 2012;37:221–31.

    CAS  PubMed  Google Scholar 

  52. Lakey WC, Spratt S, Vinson EN, Gesty-Palmer D, Weber T, et al. Osteoporosis in lung transplant candidates to matched healthy controls. Clin Transpl. 2011;25:426–35.

    Article  Google Scholar 

  53. Spira A, Gutierrez C, Chaparro C, Hutcheon MA, Chan CK. Osteoporosis and lung transplantation: prospective study. Chest. 2000;117:476–81.

    Article  CAS  PubMed  Google Scholar 

  54. Shane E, Silverberg SJ, Donovan D, Papadopoulos A, Staron RB, et al. Osteoporosis in lung transplant candidates with end-stage pulmonary disease. Am J Med. 1996;101:262–9.

    Article  CAS  PubMed  Google Scholar 

  55. Dodd VA, Staron RB, Papadopoulos A, Evans L, Schulman LL, et al. Bone densitometry should be included in the evaluation of candidates for lung transplantation. J Transpl Coord. 1999;9:119–23.

    Article  CAS  PubMed  Google Scholar 

  56. Wang TKM, O’Sullivan S, Gamble GD, Ruygrok PN. Bone density in heart and lung transplant recipients—a longitudinal study. Transplant Proc. 2013;45:2357–65.

    Article  CAS  PubMed  Google Scholar 

  57. Hariman A, Alex C, Heroux A, Camacho P. Incidence of fractures after cardiac and lung transplantation; a single center experience. J Osteoporos. 2014. doi:10.115/2014/573041.

    PubMed Central  PubMed  Google Scholar 

  58. Sambrook P, Henderson NK, Keogh A, MacDonald P, Glanville A, et al. Effect of calcitriol on bone loss or cardiac or lung transplant. J Bone Miner Res. 2000;15:1818–24.

    Article  CAS  PubMed  Google Scholar 

  59. Stein EM, Ortiz D, Jin Z, McMahon DJ, Shane E. Prevention of fractures after solid organ transplantation; a meta-analysis. J Clin Endocrinol Metab. 2011;96:3457–65.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  60. Acasoy SM, Wilt J. Medical complications after lung transplantation. Semin Respir Crit Care Med. 2006;27:508–20.

    Article  Google Scholar 

  61. End A, Stift A, Wieselthaler G, Griesmacher A, Schlecta B, et al. Anemia and erythropoietin levels and lung transplant recipients. Transplantation. 1995;60:1245–51.

    Article  CAS  PubMed  Google Scholar 

  62. Blosser CD, Bloom RD. Posttransplant anemia in solid organ recipients. Transplant Rev. 2010;24:89–98.

    Article  Google Scholar 

  63. Borie R, Kannengiesser C, Hirschi S, Le Pavec J, Mal H, et al. Severe to logic complications after lung transplantation in patients with telomerase complex mutations. J Heart Lung Transplant. 2014;14:S1053–2498.

    Google Scholar 

  64. Jacobs F, Mamzer-Bruneel MF, Skhiri H, et al. Safety of mycophenolate mofetil-allopurinol combination and kidney transplant recipients with gout. Transplantation. 1977;64:1087–8.

    Google Scholar 

  65. Boyer NL, Niven A, Edelman J. Tacrolimus associated thrombotic microangiopathic the in a lung transplant recipient. BMJ Case Rep Published online: doi: 10.1136/bcr-2012-007351.

  66. Horlait G, Bulpa P, Evrard P. Passenger lymphocytic syndrome mimicking hemolytic uremic syndrome after lung transplantation. J Heart Lung Transplant. 2013;32:271–2.

    Article  PubMed  Google Scholar 

  67. Afshar K, Orijioke N, Whelan T. Medical complications and lung transplant recipients with pulmonary fibrosis. J Pulmon Resp Med. 2013;3:1–6.

    Google Scholar 

  68. Kahan BD. Cyclosporine. N Engl J Med. 1989;321:1725–38.

    Article  CAS  PubMed  Google Scholar 

  69. Vaughn BV, Ali II, Olivier KN, Lackner RP, Robertson KR, et al. Seizures in lung transplant recipients. Epilepsia. 1996;37:1175–9.

    Article  CAS  PubMed  Google Scholar 

  70. Facchini A, Magnoni S, Civelli V, Triulzi F, Nosotti M, et al. Refractory intracranial hypertension in posterior reversible encephalopathy syndrome. Neurocrit Care. 2013;19:376–80.

    Article  PubMed  Google Scholar 

  71. Shigemura N, Sclabassi RJ, Bhama JK, Gries CJ, Crespo MM, et al. Early nature neurological complications after lung transplantation: incidence, risk factors and outcome. Transplantation. 2013;95:866–71. This study looks at early neurologic events after lung transplantation and their impact on early and later outcomes.

  72. Hoffman BM, Blumenthal JA, Carney RC, O’Hayer CVF, Freeland K, et al. Changes in neurocognitive functioning following lung transplantation. Am J Transplant. 2012;12:2519–25.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  73. Hall EC, Pfeiffer RM, Segev DL, Engels EA. Cumulative incidence of cancer after solid organ transplantation. Cancer. 2013;119:2300–8.

    Article  PubMed Central  PubMed  Google Scholar 

  74. Kyrnitz B, Edgren G, Lindelof B, Baecklund E, Brattstrom C, et al. Risk of skin cancer and other malignancies and kidney, liver, heart and lung transplant recipients 1972-2008—a Swedish population based study. Int J Cancer. 2013;132:1429–38.

    Article  Google Scholar 

  75. Euvards S, Morelon E, Rostaing L, et al. TUMORAPA Study Group. Sirolimus and secondary skin cancer prevention and kidney transplantation. N Engl J Med. 2012;367:329–39.

    Article  Google Scholar 

  76. Singer JP, Boker A, Metchnikoff C, Binstock M, Boettger R, et al. High cumulative dose exposure to voriconazole is associated with cutaneous squamous cell carcinoma in lung transplant recipients. J Heart Lung Transplant. 2012;31:694–49.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

The authors declare that they have no conflicts of interests to declare.

Human and Animal Rights and Informed Consent

This article contains no studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Medical Director Lung Transplant, Heart-Lung Transplant Program, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Marie M. Budev

  2. Section of Cardiac Surgery, Yale School of Medicine, 330 Cedar Street, BB 204, PO Box 208039, New Haven, CT, 06510, USA

    James J. Yun

Authors
  1. Marie M. Budev
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James J. Yun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marie M. Budev.

Additional information

This article is part of the Topical Collection on Lung Transplant

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Budev, M.M., Yun, J.J. Medical complications after lung transplantation. Curr Pulmonol Rep 4, 97–104 (2015). https://doi.org/10.1007/s13665-015-0115-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13665-015-0115-7

Keywords

Search

Navigation