International consensus recommendations for anesthetic and intensive care management of lung transplantation. An EACTAIC, SCA, ISHLT, ESOT, ESTS, and AST approved document

For patients with end-stage lung disease, LTx remains the only therapeutic option toward better chance of survival as well as improved quality of life. According to the International Society for Heart and Lung Transplantation (ISHLT) Transplant Registry, the number of LTx procedures has been rising despite limitations in available and suitable donor lungs and in the face of persistent donor shortages.1 The modern era of LTx is characterized by increasing complexity of recipient candidates including those receiving bridging extracorporeal support, a trend toward acceptance of suboptimal or extended criteria donors, and increasingly complicated surgical strategies.2 Despite these adverse conditions, contemporary survival figures for LTx continues to improve, especially considering the early period after LTx.1,2 While these achievements are remarkable and only possible by pushing the limits of what is conceivable, the procedure remains associated with high perioperative morbidity and mortality and the lowest long-term survival of all solid organ transplants. The leading cause of perioperative mortality, remains primary graft dysfunction (PGD).3-8 Registry data and recent randomized clinical trials conducted with the involvement of the leading transplant centers identify nearly 30% prevalence of severe allograft dysfunction with important influence on patient recovery, allograft quality, long term survival and quality of life.9 Beyond PGD, surgical complications account for approximately 10% of the perioperative mortality and infections are responsible for another 20%. Moreover, there is increasing evidence that in-hospital, extra-pulmonary complications comprising mainly of renal, cardiac, hepatic, and vascular adverse events are nearly ubiquitous and impact negatively on long-term outcomes.