How are patients monitored in the early postoperative period following 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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Answer

The first 3 months following transplantation is the early postoperative period.

Daily chest radiographs are required in the first postoperative week. These are reduced in frequency according to the patient's clinical status. Spirometry is performed as soon as is practical after surgery, at predischarge, and periodically thereafter. Some centers have the patients perform daily home spirometry and report any drop in forced expiratory volume in 1 second (FEV1) of 5-10%. The FEV1, forced vital capacity (FVC), and diffusing capacity steadily rise in the lung transplant recipient during the first 3 months.

Fiberoptic bronchoscopy and bronchoalveolar lavage are performed if the patient demonstrates new infiltrates on chest radiographs, a decrease in lung function on spirometry, or the presence of new symptoms. Transbronchial biopsies completed at the time of bronchoscopy are used to assess the presence of acute rejection.

The role of routine transbronchial lung biopsy in an asymptomatic patient with stable lung function is controversial. [43] However, most centers perform surveillance bronchoscopies and transbronchial biopsies in order to detect asymptomatic acute rejection. Acute rejections that are greater than A2 category are treated with enhanced immunosuppression. The overall utility of this practice has not been established in clinical trials.


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