Abstract
As survival following thoracic organ transplantation improves, anesthesiologists are increasingly likely to see transplant recipients presenting for noncardiac surgery. Therefore, anesthesiologists and surgeons need a basic knowledge of the physiologic changes that occur in the immediate postoperative period and years following thoracic organ transplantation. During the preoperative workup period, it is advantageous for dedicated transplant teams to be involved in discussions regarding these patients; however, this is not always possible because of time constraints. Therefore, general anesthesiologists must be prepared to manage transplant recipients.
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Organ Procurement and Transplantation Network [Internet]. [Place unknown]: [Publisher unknown]; Date first published [updated 2014 November 21, cited 2014 November 24]. Available from: http://optn.transplant.hrsa.gov/latestData/viewDataReports.asp
Fazel S, Everson EA, Stitt LW, Smith C, Quantz M, McKenzie FN, et al. Predictors of general surgical complications after heart transplantation. J Am Coll Surg. 2001;193(1):52–9.
Cheng DCH, Ong DD. Anaesthesia for non-cardiac surgery in heart-transplanted patients. Can J Anaesth. 1993;40(10):981–6.
Melendez JA, Delphin E, Lamb J, Rose E. Noncardiac surgery in heart transplant recipients in the cyclosporine era. J Cardiothorac Vasc Anesth. 1991;5(3):218–20.
Bhatia DS, Bowen JC, Money SR, Van Meter Jr CH, McFadden PM, Kot JB, et al. The incidence, morbidity, and mortality of surgical procedures after orthotopic heart transplantation. Ann Surg. 1997;225(6):686–93.
Blasco LM, Parameshwar J, Vuylsteke A. Anaesthesia for noncardiac surgery in the heart transplant recipient. Curr Opin Anaesthesiol. 2009;22(1):109–13.
Kostopanagiotou G, Smyrniotis V, Arkadopoulos N, Theodoraki K, Papdimitriou L, Papadimitriou J. Anesthetic and perioperative management of adult transplant recipients in non-transplant surgery. Anesth Analg. 1999;89(3):613–22.
Stover EP, Siegel LC. Physiology of the transplanted heart. Int Anesthesiol Clin. 1995;33(2):11–20.
Gaer J. Physiological consequences of complete cardiac denervation. Br J Hosp Med. 1992;48(5):220–5.
Squires RW, Leung TC, Cyr NS, Allison TG, Johnson BD, Ballman KV, et al. Partial normalization of the heart rate response to exercise after cardiac transplantation: frequency and relationship to exercise capacity. Mayo Clin Proc. 2002;77:1295–300.
Fuentes FB, Martinez-Dolz L, Bonet LA, Sanchez-Lazaro L, Manchon JN, Sanchez-Gomez JM, et al. Normalization of the heart rate response to exercise 6 months after cardiac transplantation. Transplant Proc. 2010;42:3186–8.
Bengel FM, Ueberfuhr P, Ziegler SI, Nekolla S, Reichart B, Schwaiger M. Serial assessment of sympathetic reinnervation after orthotopic heart transplantation: a longitudinal study using PET and C-11 hydroxyephedrine. Circulation. 1999;99:1866–71.
Swami AC, Kumar A, Rupal S, Lata S. Anaesthesia for non-cardiac surgery in a cardiac transplant recipient. Indian J Anaesth. 2011;55(4):405–7.
Gomez-Rios MA. Anaesthesia for non-cardiac surgery in a cardiac transplant recipient. Indian J Anaesth. 2012;56(1):88–9.
Bjerke RJ, Mangione MP. Asystole after intravenous neostigmine in a heart transplant recipient. Can J Anaesth. 2001;48(3):305–7.
Beebe DS, Shumway SJ, Maddock R. Sinus arrest after intravenous neostigmine in two heart transplant recipients. Anesth Analg. 1994;78(4):779–82.
Sawasdiwipachai P, Laussen PC, McGowan FX, Smoot L, Casta A. Cardiac arrest after neuromuscular blockade reversal in a heart transplant infant. Anesthesiology. 2007;107(4):663–5.
Backman SB, Ralley FE, Fox GS. Neostigmine produces bradycardia in a heart transplant patient. Anesthesiology. 1993;78(4):777–9.
Taylor DO, Stehlik J, Edwards LB, Aurora P, Christie JD, Dobbels F, et al. Registry of the International Society for Heart and Lung Transplantation: Twenty-sixth Official Adult Heart Transplant Report—2009. J Heart Lung Transplant. 2009;28(10):1007–22.
O’Connell JB, Bourge RC, Costanzo-Nordin MR, Driscoll DJ, Morgan JP, Rose EA, et al. Cardiac transplantation: recipient selection, donor procurement, and medical follow-up. A statement for health professionals from the Committee on Cardiac Transplantation of the Council on Clinical Cardiology, American Heart Association. Circulation. 1992;86(3):1061–79.
Kobashigawa JA. Postoperative management following heart transplantation. Transplant Proc. 1999;31:2038–46.
Gude E, Andreassen AK, Arora S, Gullestad L, Grov I, Hartmann A, et al. Acute renal failure early after heart transplantation: risk factors and clinical consequences. Clin Transplant. 2010;24(6):207–13.
Stehlik J, Edwards LB, Kucheryavaya AY, Benden C, Christie JD, Dipchand AL. The Registry of the International Society for Heart and Lung Transplantation: 29th official adult heart transplant report—2012. J Heart Lung Transplant. 2012;31(10):1052–64.
Crespo-Leiro MG, Marzoa-Rivas R, Barge-Caballero E, Paniagua-Martin MJ. Prevention and treatment of coronary artery vasculopathy. Curr Opin Organ Transplant. 2012;17(5):546–50.
Kobashigawa JA. What is the optimal prophylaxis for treatment of cardiac allograft vasculopathy? Curr Control Trials Cardiovasc Med. 2000;1:166–71.
Bellet M, Cabrol C, Sassano P, Leger P, Corvol P, Menard J. Systemic hypertension after cardiac transplantation: effect of cyclosporine on the rennin-angiotensin-aldosterone system. Am J Cardiol. 1985;56(15):927–31.
Olivari MT, Antolick A, Ring WS. Arterial hypertension in heart transplant recipients treated with triple-drug immunosuppressive therapy. J Heart Transplant. 1989;8:34–9.
Scherrer U, Vissing SF, Morgan BJ, Rollins JA, Tindall RSA, Ring S, et al. Cyclosporine-induced sympathetic activation and hypertension after heart transplantation. N Engl J Med. 1990;323(11):693–9.
Starling RC, Cody RJ. Cardiac transplantation hypertension. Am J Cardiol. 1990;65:106–11.
Sanchez Lazaro IJ, Bonet LA, Martinez-Dolz L, Lopez JM, Ramon-Llin JA, Perez OC, et al. Hypertension after heart transplantation: predictive factors and number and classes of drugs for its management. Transplant Proc. 2008;40(9):3051–2.
Myers BD, Sibley R, Newton L, Tomlanovich SJ, Boshkos C, Stinson E, et al. The long-term course of cyclosporine-associated chronic nephropathy. Kidney Int. 1988;33(2):590–600.
Myers BD, Ross J, Newton L, Luetscher J, Perlroth M. Cyclosporine-associated chronic nephropathy. N Engl J Med. 1984;311(11):699–705.
Harmour IM, Omar F, Lyster HS, Palmer A, Banner NR. Chronic kidney disease after heart transplantation. Nephrol Dial Transplant. 2009;24:1655–62.
Thomas HL, Banner NR, Murphy CL, Steenkamp R, Birch R, Fogarty DG, et al. Incidence, determinants, and outcome of chronic kidney disease after adult heart transplantation in the United Kingdom. Transplantation. 2012;93(11):1151–7.
Delgado JF, Crespo-Leiro MG, Gomez-Sanchez MA, Paniagua MJ, Gonzalez-Vilchez F, Vazquez de Prada JA, et al. Risk factors associated with moderate-to-severe renal dysfunction among heart transplant patients: results from the CAPRI study. Clin Transplant. 2010;24(5):194–200.
Holt ND, McComb JM. Cardiac transplantation and pacemakers: when and what to implant. Card Electrophysiol Rev. 2002;6:140–51.
Cantillion DJ, Gorodeski EZ, Caccamo M, Smedira NG, Wilkoff BL, Starling RC, et al. Long-term outcomes and clinical predictors for pacing after cardiac transplantation. J Heart Lung Transplant. 2009;28(8):791–8.
Cantillion DJ, Tarakji KG, Hu T, Hsu A, Smedira NG, Starling RC, et al. Long-term outcomes and clinical predictors for pacemaker-requiring bradyarrhythmias after cardiac transplantation: analysis of the UNOS/OPTN cardiac transplant database. Heart Rhythm. 2010;7(11):1567–71.
Zieroth S, Ross H, Rao V, Delgado DH, Cusimano RJ, Thevarajah M, et al. Permanant pacing after cardiac transplantation in the era of extended donors. J Heart Lung Transplant. 2006;25(9):1142–7.
Espana A, Redondo P, Fernandez AL, Zabala M, Herreros J, Llorens R, et al. Skin cancer in heart transplant recipients. J Am Acad Dermatol. 1995;32(3):458–65.
Lampros TD, Cobanoglu A, Parker F, Ratkovec R, Norman DJ, Hershberger R. Squamous and basal cell carcinoma in heart transplant recipients. J Heart Lung Transplant. 1998;17(6):586–91.
Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). OPTN/SRTR 2011 Annual Data Report. Rockville, MD: Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation; 2012.
Kanter SF, Samuels SI. Anesthesia for major operations on patients who have transplanted hearts, a review of 29 cases. Anesthesiology. 1977;46(1):65–8.
Watson CJ, Jamieson NV, Johnston PS, Wreghitt T, Large S, Wallwork J, et al. Early abdominal complications following heart and heart-lung transplantation. Br J Surg. 1991;78(6):699–704.
Shaw IH, Kirk AJB, Conacher ID. Anaesthesia for patients with transplanted hearts and lungs undergoing non-cardiac surgery. Br J Anaesth. 1991;67:772–8.
Johnston TD, Katz SM. Special considerations in the transplant patient requiring other surgery. Surg Clin North Am. 1994;74(5):1211–21.
Feltracco P, Falasco G, Barbieri S, Milevoj M, Serra E, Ori C. Anesthetic considerations for non-transplant procedures in lung transplant patients. J Clin Anesth. 2011;23:508–16.
Christie JD, Edwards LB, Kucheryavaya AY, Benden C, Dipchand AI, Dobbels F, et al. The Registry of the International Society for Heart and Lung Transplantation: 29th adult lung and heart-lung transplant report—2012. J Heart Lung Transplant. 2012;31(10):1073–86.
Higenbottam T, Jackson M, Woolman P, Lowry R, Wallwork J. The cough response to ultrasonically nebulized distilled water in heart-lung transplantation patients. Am Rev Respir Dis. 1989;140(1):58–61.
Duarte AG, Myers AC. Cough reflex in lung transplant recipients. Lung. 2012;190(1):23–7.
Bradley GW, Hale T, Pimble J, Rowlandson R, Noble MIM. Effect of vagotomy on the breathing pattern and exercise ability in emphysematous patients. Clin Sci. 1982;62(3):311–9.
Duarte AG, Terminella L, Smith JT, Myers AC, Campbell G, Lick S. Restoration of cough reflex in lung transplant recipients. Chest. 2008;134(2):310–6.
Herve P, Silbert D, Cerrina J, Simonneau G, Dartevelle P. Impairment of bronchial mucociliary clearance in long-term survivors of heart/lung and double-lung transplantation. The Paris-Sud Lung Transplant Group. Chest. 1993;103(1):59–63.
Paul A, Marelli D, Shennib H, King M, Wang NS, Wilson JA, et al. Mucociliary function in autotransplanted, allotransplanted, and sleeve resected lungs. J Thorac Cardiovasc Surg. 1989;98(4):523–8.
Haddow GR. Anaesthesia for patients after lung transplantation. Can J Anaesth. 1997;44(2):182–97.
The Toronto Lung Transplant Group. Experience with single-lung transplantation for pulmonary fibrosis. JAMA. 1988;259(15):2258–62.
Robin ED, Theodore J, Burke CM, Oesterle SN, Fowler MB, Jamieson SW, et al. Hypoxic pulmonary vasoconstriction persists in the human transplanted lung. Clin Sci. 1987;72(3):283–7.
Sugita M, Ferraro P, Dagenais A, Clermont ME, Barbry P, Michel RP, et al. Alveolar liquid clearance and sodium channel expression are decreased in transplanted canine lungs. Am J Respir Crit Care Med. 2003;167(10):1440–50.
Ruggiero R, Muz J, Fietsam Jr R, Thomas GA, Welsh RJ, Miller JE, et al. Reestablishment of lymphatic drainage after canine lung transplantation. J Thorac Cardiovasc Surg. 1993;106(1):167–71.
Egan TM, Cooper JD. The lung following transplantation. In: Crystal RG, West JB, et al., editors. The lung: Scientific foundations. New York: Raven Press Ltd.; 1991. p. 2205–15.
Boehler A, Estenne M. Obliterative bronchiolitis after lung transplantation. Curr Opin Pulm Med. 2000;6(2):133–9.
Todd JL, Palmer SM. Bronchiolitis obliterans syndrome: the final frontier for lung transplantation. Chest. 2011;140(2):502–8.
Valentine VG, Robbins RC, Berry GJ, Patel HR, Reichenspurner H, Reitz BA, et al. Actuarial survival of heart-lung and bilateral sequential lung transplant recipients with obliterative bronchiolitis. J Heart Lung Transplant. 1996;15(4):371–83.
Burke CM, Theodore J, Dawkins KD, Yousem SA, Blank N, Billingham ME, et al. Post-transplant obliterative bronchiolitis and other late lung sequelae in human heart-lung transplantation. Chest. 1984;86(6):824–9.
Finlen Copeland CA, Snyder LD, Zaas DW, Turbyfill WJ, Davis WA, Palmer SM. Survival after bronchiolitis obliterans syndrome among bilateral lung transplant recipients. Am J Respir Crit Care Med. 2010;182(6):784–9.
Estenne M, Maurer JR, Boehler A, Egan JJ, Frost A, Hertz M, et al. Bronchiolitis obliterans syndrome 2001: an update to the diagnostic criteria. J Heart Lung Transplant. 2002;21(3):297–310.
Kukafka DS, O’Brien GM, Furukawa S, Criner GJ. Surveillance bronchoscopy in lung transplant recipients. Chest. 1997;111(2):377–81.
Belperio JA, Lake K, Tazelaar H, Keane MP, Strieter RM, Lynch JP. Bronchiolitis obliterans syndrome complicating lung or heart-lung transplantation. Semin Respir Crit Care Med. 2003;24(5):499–530.
Kramer MR, Marshall SE, Starnes VA, Gamberg P, Amitai Z, Theodore J. Infectious complications in heart-lung transplantation. Analysis of 200 episodes. Arch Intern Med. 1993;153(17):2010–6.
Arcasoy SM, Kotloff RM. Lung transplantation. N Engl J Med. 1999;340(14):1081–91.
Remund KF, Best M, Egan JJ. Infections relevant to lung transplantation. Proc Am Thorac Soc. 2009;6(1):94–100.
Maurer JR, Tullis DE, Grossman RF, Vellend H, Winton TL, Patterson GA. Infectious complications following isolated lung transplantation. Chest. 1992;101(4):1056–9.
Paul S, Escareno CE, Clancy K, Jaklitsch MT, Bueno R, Lautz DB. Gastrointestinal complications after lung transplantation. J Heart Lung Transplant. 2009;28(5):475–9.
Hoekstra HJ, Hawkins K, de Boer WJ, Rottier K, van der Bij W. Gastrointestinal complications in lung transplant survivors that require surgical intervention. Br J Surg. 2001;88(3):433–8.
Gilljam M, Chaparro C, Tullis E, Chan C, Keshavjee S, Hutcheon M. GI complications after lung transplantation in patients with cystic fibrosis. Chest. 2003;123:37–41.
Smith PC, Slaughter MS, Petty MG, Shumway SJ, Kshettry VR, Bolman RM. Abdominal complications after lung transplantation. J Heart Lung Transplant. 1995;14(1):44–51.
Hogan K, Rusy D, Springman SR. Difficult laryngoscopy and diabetes mellitus. Anesth Analg. 1988;67(12):1162–5.
Haddow GR, Brock-Utne JG. A non-thoracic operation for a patient with a single lung transplantation. Acta Anaesth Scand. 1999;43:960–3.
Mitchell JB, Shaw ADS, Donald S, Farrimond JG. Differential lung ventilation after single-lung transplantation for emphysema. J Cardiothorac Vasc Anesth. 2002;16(4):459–62.
Aliabadi A, Cochrane AB, Zuckermann AO. Current strategies and future trends in immunosuppression after heart transplantation. Curr Opin Organ Transplant. 2012;17(5):540–5.
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Baisden, J.S. (2017). Anesthesia for Noncardiac Surgery Following Thoracic Organ Transplantation. In: Subramaniam, K., Sakai, T. (eds) Anesthesia and Perioperative Care for Organ Transplantation. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6377-5_18
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