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Difficult Decisions in Cardiothoracic Critical Care Surgery pp 363–379Cite as

Lung Infiltrates in Post-Operative Lung Transplant Patients: Pneumonia, Rejection or Edema?

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Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

Abstract

While lung transplantation is a potentially life-saving therapeutic option for many patients with end-stage pulmonary disease, overall outcomes remain inferior to recipients of other solid organ transplants. The immediate post-operative period presents a particularly high risk time for this extremely vulnerable population with a wide array of possible early complications including infection, rejection, pulmonary edema, primary graft dysfunction, bleeding, wound and airway complications, and venous thromboembolism. This chapter reviews important diagnostic considerations for lung transplant recipients with pulmonary infiltrates in the immediate post-operative period, specifically pertaining to infection, rejection, and pulmonary edema.

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References

  1. Chambers DC, Yusen RD, Cherikh WS, Goldfarb SB, Kucheryavaya AY, Khusch K, Levvey BJ, Lund LH, Meiser B, Rossano JW, et al. The registry of the International Society for Heart and Lung Transplantation: thirty-fourth adult lung and heart-lung transplantation report-2017; focus theme: allograft ischemic time. J Heart Lung Transplant. 2017;36:1047–59.

    Article  Google Scholar 

  2. Van Raemdonck D, Hartwig MG, Hertz MI, Davis RD, Cypel M, Hayes D Jr, Ivulich S, Kukreja J, Lease ED, Loor G, et al. Report of the ISHLT working group on primary lung graft dysfunction part IV: prevention and treatment: a 2016 consensus group statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2017;36:1121–36.

    Article  Google Scholar 

  3. Leal S, Sacanell J, Riera J, Masclans JR, Rello J. Early postoperative management of lung transplantation. Minerva Anestesiol. 2014;80:1234–45.

    CAS  PubMed  Google Scholar 

  4. King CS, Valentine V, Cattamanchi A, Franco-Palacios D, Shlobin OA, Brown AW, Singh R, Bogar L, Nathan SD. Early postoperative management after lung transplantation: results of an international survey. Clin Transplant 2017;31:e12985.

    Article  Google Scholar 

  5. Aguilar-Guisado M, Givalda J, Ussetti P, Ramos A, Morales P, Blanes M, Bou G, de la Torre-Cisneros J, Roman A, Borro JM, et al. Pneumonia after lung transplantation in the RESITRA Cohort: a multicenter prospective study. Am J Transplant. 2007;7:1989–96.

    Article  CAS  Google Scholar 

  6. Bonde PN, Patel ND, Borja MC, Allan SH, Barreiro CJ, Williams JA, Thakur NA, Orens JB, Conte JV. Impact of donor lung organisms on post-lung transplant pneumonia. J Heart Lung Transplant. 2006;25:99–105.

    Article  Google Scholar 

  7. Valentine VG, Gupta MR, Walker JE Jr, Seoane L, Bonvillain RW, Lombard GA, Weill D, Dhillon GS. Effect of etiology and timing of respiratory tract infections on development of bronchiolitis obliterans syndrome. J Heart Lung Transplant. 2009;28:163–9.

    Article  Google Scholar 

  8. Weill D, Dey GC, Hicks RA, Young KR Jr, Zorn GL Jr, Kirklin JK, Early L, McGiffin DC. A positive donor gram stain does not predict outcome following lung transplantation. J Heart Lung Transplant. 2002;21:555–8.

    Article  Google Scholar 

  9. Avlonitis VS, Krause A, Luzzi L, Powell H, Phillips JA, Corris PA, Gould FK, Dark JH. Bacterial colonization of the donor lower airways is a predictor of poor outcome in lung transplantation. Eur J Cardiothorac Surg. 2003;24:601–7.

    Article  Google Scholar 

  10. Campos S, Caramori M, Teixeira R, Afonso J Jr, Carraro R, Strabelli T, Samano M, Pego-Fernandes P, Jatene F. Bacterial and fungal pneumonias after lung transplantation. Transplant Proc. 2008;40:822–4.

    Article  CAS  Google Scholar 

  11. Ison MG, Grossi P. Donor-derived infections in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):22–30.

    Article  Google Scholar 

  12. Mattner F, Fischer S, Weissbrodt H, Chaberny IF, Sohr D, Gottlieb J, Welte T, Henke-Gendo C, Gastmeier P, Strueber M. Post-operative nosocomial infections after lung and heart transplantation. J Heart Lung Transplant. 2007;26:241–9.

    Article  Google Scholar 

  13. Riera J, Caralt B, Lopez I, Augustin S, Roman A, Gavalda J, Rello J. Ventilator-associated respiratory infection following lung transplantation. Eur Respir J. 2015;45:726–37.

    Article  Google Scholar 

  14. Palacio F, Reyes LF, Levine DJ, Sanchez JF, Angel LF, Fernandez JF, Levine SM, Rello J, Abedi A, Restrepo MI. Understanding the concept of health care-associated pneumonia in lung transplant recipients. Chest. 2015;148:516–22.

    Article  Google Scholar 

  15. Dudau D, Camous J, Marchand S, Pilorge C, Rezaiguia-Delclaux S, Libert JM, Fadel E, Stephan F. Incidence of nosocomial pneumonia and risk of recurrence after antimicrobial therapy in critically ill lung and heart-lung transplant patients. Clin Transplant. 2014;28:27–36.

    Article  Google Scholar 

  16. Penninga L, Moller CH, Penninga EI, Iversen M, Gluud C, Steinbruchel DA. Antibody induction therapy for lung transplant recipients. Cochrane Database Syst Rev. 2013;11:Cd008927.

    Google Scholar 

  17. Koutsokera A, Levy L, Pal P, Orchanian-Cheff A, Martinu T. Acute cellular rejection: is it still relevant? Semin Respir Crit Care Med. 2018;39:181–98.

    Article  Google Scholar 

  18. Mangi AA, Mason DP, Nowicki ER, Batizy LH, Murthy SC, Pidwell DJ, Avery RK, McCurry KR, Pettersson GB, Blackstone EH. Predictors of acute rejection after lung transplantation. Ann Thorac Surg. 2011;91:1754–62.

    Article  Google Scholar 

  19. Krustrup D, Iversen M, Martinussen T, Andersen CB. Time elapsed after transplantation influences the relationship between the number of regulatory T cells in lung allograft biopsies and subsequent acute rejection episodes. Transpl Immunol. 2014;31:42–7.

    Article  CAS  Google Scholar 

  20. Levine DJ, Glanville AR, Aboyoun C, Belperio J, Benden C, Berry GJ, Hachem R, Hayes D Jr, Neil D, Reinsmoen NL, et al. Antibody-mediated rejection of the lung: a consensus report of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2016;35:397–406.

    Article  Google Scholar 

  21. Frost AE, Jammal CT, Cagle PT. Hyperacute rejection following lung transplantation. Chest. 1996;110:559–62.

    Article  CAS  Google Scholar 

  22. Choi JK, Kearns J, Palevsky HI, Montone KT, Kaiser LR, Zmijewski CM, Tomaszewski JE. Hyperacute rejection of a pulmonary allograft. Immediate clinical and pathologic findings. Am J Respir Crit Care Med. 1999;160:1015–8.

    Article  CAS  Google Scholar 

  23. Bittner HB, Dunitz J, Hertz M, Bolman MR 3rd, Park SJ. Hyperacute rejection in single lung transplantation – case report of successful management by means of plasmapheresis and antithymocyte globulin treatment. Transplantation. 2001;71:649–51.

    Article  CAS  Google Scholar 

  24. de la Campo-Canaveral Cruz JL, Naranjo JM, Salas C, Varela de Ugarte A. Fulminant hyperacute rejection after unilateral lung transplantation. Eur J Cardiothorac Surg. 2012;42:373–5.

    Google Scholar 

  25. Dawson KL, Parulekar A, Seethamraju H. Treatment of hyperacute antibody-mediated lung allograft rejection with eculizumab. J Heart Lung Transplant. 2012;31:1325–6.

    Article  Google Scholar 

  26. Masson E, Stern M, Chabod J, Thevenin C, Gonin F, Rebibou JM, Tiberghien P. Hyperacute rejection after lung transplantation caused by undetected low-titer anti-HLA antibodies. J Heart Lung Transplant. 2007;26:642–5.

    Article  Google Scholar 

  27. de Jesus Peixoto Camargo J, Marcantonio Camargo S, Marcelo Schio S, Noguchi Machuca T, Adelia Perin F. Hyperacute rejection after single lung transplantation: a case report. Transplant Proc. 2008;40:867–9.

    Article  Google Scholar 

  28. Scornik JC, Zander DS, Baz MA, Donnelly WH, Staples ED. Susceptibility of lung transplants to preformed donor-specific HLA antibodies as detected by flow cytometry. Transplantation. 1999;68:1542–6.

    Article  CAS  Google Scholar 

  29. Le Pavec J, Suberbielle C, Lamrani L, Feuillet S, Savale L, Dorfmuller P, Stephan F, Mussot S, Mercier O, Fadel E. De-novo donor-specific anti-HLA antibodies 30 days after lung transplantation are associated with a worse outcome. J Heart Lung Transplant. 2016;35:1067–77.

    Article  Google Scholar 

  30. Snyder LD, Wang Z, Chen DF, Reinsmoen NL, Finlen-Copeland CA, Davis WA, Zaas DW, Palmer SM. Implications for human leukocyte antigen antibodies after lung transplantation: a 10-year experience in 441 patients. Chest. 2013;144:226–33.

    Article  Google Scholar 

  31. Ius F, Sommer W, Tudorache I, Kühn C, Avsar M, Siemeni T, Salman J, Hallensleben M, Kieneke D, Greer M, et al. Early donor-specific antibodies in lung transplantation: risk factors and impact on survival. J Heart Lung Transplant. 2014;33:1255–63.

    Article  Google Scholar 

  32. Park CH, Paik HC, Haam SJ, Lim BJ, Byun MK, Shin JA, Kim HJ, Hwang SH, Kim TH. HRCT features of acute rejection in patients with bilateral lung transplantation: the usefulness of lesion distribution. Transplant Proc. 2014;46:1511–6.

    Article  CAS  Google Scholar 

  33. Gotway MB, Dawn SK, Sellami D, Golden JA, Reddy GP, Keith FM, Webb WR. Acute rejection following lung transplantation: limitations in accuracy of thin-section CT for diagnosis. Radiology. 2001;221:207–12.

    Article  CAS  Google Scholar 

  34. Burns KE, Johnson BA, Iacono AT. Diagnostic properties of transbronchial biopsy in lung transplant recipients who require mechanical ventilation. J Heart Lung Transplant. 2003;22:267–75.

    Article  CAS  Google Scholar 

  35. Mohanka MR, Mehta AC, Budev MM, Machuzak MS, Gildea TR. Impact of bedside bronchoscopy in critically ill lung transplant recipients. J Bronchology Interv Pulmonol. 2014;21:199–207.

    Article  Google Scholar 

  36. Ware LB, Lee JW, Wickersham N, Nguyen J, Matthay MA, Calfee CS. Donor smoking is associated with pulmonary edema, inflammation and epithelial dysfunction in ex vivo human donor lungs. Am J Transplant. 2014;14:2295–302.

    Article  CAS  Google Scholar 

  37. Clark SC, Levine AJ, Hasan A, Hilton CJ, Forty J, Dark JH. Vascular complications of lung transplantation. Ann Thorac Surg. 1996;61:1079–82.

    Article  CAS  Google Scholar 

  38. Currey J, Pilcher DV, Davies A, Scheinkestel C, Botti M, Bailey M, Snell G. Implementation of a management guideline aimed at minimizing the severity of primary graft dysfunction after lung transplant. J Thorac Cardiovasc Surg. 2010;139:154–61.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA, USA

    Siddhartha G. Kapnadak & Erika D. Lease

  2. Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, WA, USA

    Michael S. Mulligan

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  1. Siddhartha G. Kapnadak
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  2. Erika D. Lease
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  3. Michael S. Mulligan
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Correspondence to Michael S. Mulligan .

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Editors and Affiliations

  1. University of Chicago Medicine, Chicago, IL, USA

    Vassyl A. Lonchyna

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Kapnadak, S.G., Lease, E.D., Mulligan, M.S. (2019). Lung Infiltrates in Post-Operative Lung Transplant Patients: Pneumonia, Rejection or Edema?. In: Lonchyna, V. (eds) Difficult Decisions in Cardiothoracic Critical Care Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-04146-5_26

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  • DOI: https://doi.org/10.1007/978-3-030-04146-5_26

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-04145-8

  • Online ISBN: 978-3-030-04146-5

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