What are the possible surgical complications from lung transplantation?

Updated: Aug 19, 2019
  • Author: Bryan A Whitson, MD, PhD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Major technical complications following lung transplantation are rare. Pulmonary artery obstruction can occur as a result of anastomotic stenosis, kinking, or extrinsic compression. Left atrial anastomotic obstruction also can occur because of faulty anastomotic technique or extrinsic compression by a clot, pericardium, or an omental flap.

Acute graft dysfunction without evidence of vascular anastomotic complications has been described. [41] The cause is not known, but unsuspected contusion or aspiration could be possible causes. Management includes evaluation of the vascular anastomosis and maintenance of oxygenation. [42]

Pleural space complications are not uncommon, but their occurrence is considered rare. Pneumothorax may occur on either side of the lung graft or on the side of the native lung. Pleural effusions are common after lung transplantation, particularly when a significant size disparity exists. Management of these effusions usually is conservative in nature, using diuretic therapy. Thoracentesis and tube drainage are indicated only if an effusion is complicated by pneumothorax or respiratory compromise.

Airway complications have been significantly less common in the recent reports of lung transplantation. Because revascularization of the bronchial arterial circulation is not present, the donor bronchus must rely on collateral perfusion from the pulmonary circulation in the initial postimplementation period. Airway ischemia manifests as mucosal ulcerations followed by abnormalities that can range from anastomotic dehiscence to an anastomotic stenosis. However, present surgical techniques have limited the scope of these complications.

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