0
Editorials |

Respiratory Failure Early After Lung Transplantation : Now That We Know the Extent of the Problem, What Are the Solutions?

David Zaas, MD; Scott M. Palmer, MD, MHS, FCCP
Author and Funding Information

Affiliations: Durham, NC
 ,  Dr. Zaas is from the Division of Pulmonary and Critical Care Medicine, and Dr. Palmer is Assistant Professor of Medicine, Division of Pulmonary and Critical Care Medicine, and Medical Director Lung Transplant Program, Duke University Medical Center.

Correspondence to: Scott M. Palmer, MD, MHS, FCCP, Division of Pulmonary and Critical Care Medicine, DUMC 3876, Room 128, Bell Building, Duke University Medical Center, Durham, NC 27710; e-mail: Palme002@mc.duke.edu



Chest. 2003;123(1):14-16. doi:10.1378/chest.123.1.14
Text Size: A A A
Published online

Extract

Over the last 20 years, lung transplantation has emerged as a valid treatment option for a wide range of advanced lung diseases. Surgical advances combined with newer immunosuppressant medications have improved outcomes; however, both the short-term and long-term survival after lung transplant continues to lag behind other solid-organ transplants. Survival for lung transplant recipients at 1 year, 3 years, and 5 years is approximately 76%, 58%, and 47%, respectively.1 Early respiratory failure and death after lung transplant can result from airway complications, hyperacute rejection, acute rejection, infection, or ischemia/reperfusion lung injury (IRLI). Graft failure secondary to bronchial dehiscence is now rare with improved surgical techniques. Hyperacute rejection, infrequently described in lung transplantation, results from preformed antibodies that target antigens in the allograft vascular endothelium and cause extensive thrombosis and complement activation. Acute rejection occurs in > 60% of lung recipients despite current immunosuppressive protocols, but usually responds to augmented immunosuppression and rarely leads to early graft loss. Infectious complications, such as bacterial pneumonia or cytomegalovirus, have been described as a common etiology of respiratory failure and mortality in the early posttransplant period. IRLI or reimplantation response is characterized by the development of bilateral pulmonary infiltrates, declining lung compliance, and worsening of gas exchange in the immediate posttransplant period after exclusion of rejection, infection, and heart failure. Severe IRLI has been reported to occur in 15 to 30% of patients.2 Despite the increasing experience with lung transplantation, all of these problems contribute to the development of early respiratory failure and a 1-year mortality of approximately 25%.

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543