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Physiologic changes following lung transplantation

Authors
Roland G Nador, MD
Lianne G Singer, MD, FRCPC
Section Editor
Elbert P Trulock, MD
Deputy Editor
Helen Hollingsworth, MD

INTRODUCTION

Important physiologic changes occur over the months to years following lung transplantation. Some changes affect all lung transplant recipients; others may be dependent upon the type of lung transplant surgery performed (single lung transplantation (SLT), bilateral sequential or double lung transplantation (BLT), heart-lung transplantation (HLT), and living donor lobar transplantation (LDLT)), or on the pre-transplant diagnosis (eg, chronic obstructive pulmonary disease [COPD], interstitial lung disease, cystic fibrosis, pulmonary hypertension).

The effect of lung transplantation on long-term general respiratory physiology will be presented here. Other outcome measures, such as survival and quality of life, are discussed separately. (See "Lung transplantation: An overview" and "Heart-lung transplantation".)

ANATOMIC CHANGES

In the process of donor lung retrieval, the vagus and sympathetic nerves, pulmonary and bronchial blood vessels, and lymphatics are interrupted. Although the pulmonary artery and pulmonary veins are reanastomosed to those of the recipient, the bronchial arteries that supply the airways are usually not revascularized. The recipient phrenic, vagus, and recurrent laryngeal nerves are sometimes injured during the operative procedure, more commonly during heart-lung transplantation or when cardiopulmonary bypass is needed.

Postoperative respiratory function of the recipient will reflect these changes in addition to any lung injury that occurs related to the procedure. If a single lung is transplanted, postoperative function will reflect the combination of donor lung and diseased recipient lung. A discussion of the different surgical procedures is provided separately. (See "Lung transplantation: Procedure and postoperative management".)

GENERAL PHYSIOLOGIC CHANGES

Lung transplantation alters many components of respiratory physiology. Some changes result from the surgical procedure, such as denervation of the transplanted lung, interrupted cough reflex, and reduced gastroesophageal motility.

                  

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Literature review current through: Nov 2016. | This topic last updated: Fri Jul 15 00:00:00 GMT 2016.
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