Post-operative management of children after lung transplantation

Abstract

Post-operative care for children and adolescents who undergo lung transplantation is a challenge because of the potential for numerous complications during this period, which can considerably impact the short- and long-term outcomes. The immediate post-operative phase is particularly critical, and complications are frequent; therefore, knowledge, early recognition, and appropriate treatment of these complications are imperative and can only be achieved through close collaboration between a wide range of medical specialties. The aim of this review is to provide an abbreviated overview of the optimal post-operative management of children in an intensive care unit, as well as to describe frequently occurring complications and their treatment.

Keywords: Adolescents; Children; Complications; Intensive care; Lung transplantation; Post-operative management.

Figure 1

Bronchoscopic view of the right main bronchus in a patient with CF after lung transplantation; 5 days after transplantation with severe desquamative bronchitis and detection of Pseudomonas aeruginosa (A) and 8 weeks after transplantation with a resulting severe stenosis distal to the anastomosis in the intermediate bronchus (B).

Figure 2

Chest radiograph with ground-glass opacities in a 13-month-old infant with grade 3 PGD after LTX for surfactant protein B mutation.

Figure 3

Bronchoscopic view of the right main bronchus in a patient after Re-Tx with newly developed viscous, yellow-gray colored secretions and membranes in the area of the anastomosis 10 days after Ltx (A); histological examination of the extracted membranes showed typical Aspergillus hyphae (B). Of note, this patient was treated with voriconazole and inhaled amphotericin B since Re-Tx.