Postoperative care of the lung-transplant patient

The early postoperative care in the management of the lung-transplant patient has significantly changed over the past two decades. The advances in donor preservation, improved surgical techniques, better understanding of immunosuppression and nosocomial infection along with multidisciplinary care have contributed to these changes. Although management of the lung-transplant patient is similar in many aspects to that of a critically ill postsurgical patient, care of some of these patients is challenging, and a multidisciplinary team familiar with their care makes a difference. With this approach, the postoperative mortality rate is kept below 10% and the morbidity is minimized in many centers. Preoperative recipient preparation plays a key role in postoperative management and cannot be taken lightly. There are no major randomized clinical trials to draw conclusions or provide guidelines; therefore, the recommendations are made from large-volume lung-transplant centers and personal experiences, as well as experiences with major thoracic surgical procedures. This chapter summarizes the early postoperative management of patients undergoing isolated lung transplantation.