Sekulovski M, Simonska B, Peruhova M, Krastev B, Peshevska-Sekulovska M, Spassov L, Velikova T. Factors affecting complications development and mortality after single lung transplant. World J Transplant 2021; 11(8): 320-334 [PMID: 34447669 DOI: 10.5500/wjt.v11.i8.320]
Corresponding Author of This Article
Tsvetelina Velikova, MD, PhD, Assistant Professor, Department of Clinical Immunology, University Hospital Lozenetz, Kozyak 1, Sofia 1407, Bulgaria. tsvelikova@medfac.mu-sofia.bg
Research Domain of This Article
Transplantation
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Metodija Sekulovski, Bilyana Simonska, Department of Anesthesiology and Intensive care, University Hospital Lozenetz, Sofia 1407, Bulgaria
Metodija Sekulovski, Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
Milena Peruhova, Monika Peshevska-Sekulovska, Department of Gastroenterology, University Hospital Lozenetz, Sofia 1407, Bulgaria
Boris Krastev, Department of Clinical Oncology, MHAT Hospital for Women Health Nadezhda, Sofia 1330, Bulgaria
Lubomir Spassov, Department of Cardiothoracic Surgery, University Hospital Lozenetz, Sofia 1431, Bulgaria
Tsvetelina Velikova, Department of Clinical Immunology, University Hospital Lozenetz, Sofia 1407, Bulgaria
Author contributions: Sekulovski M, Simonska B, Peruhova M, Peshevska-Sekulovska M, and Krastev B wrote the draft; Spassov L and Velikova T added additional sections and proofread the final version; All authors revised and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tsvetelina Velikova, MD, PhD, Assistant Professor, Department of Clinical Immunology, University Hospital Lozenetz, Kozyak 1, Sofia 1407, Bulgaria. tsvelikova@medfac.mu-sofia.bg
Received: March 5, 2021 Peer-review started: March 5, 2021 First decision: March 31, 2021 Revised: April 15, 2021 Accepted: June 28, 2021 Article in press: June 28, 2021 Published online: August 18, 2021
Abstract
Lung transplantation (LT) is a life-saving therapeutic procedure that prolongs survival in patients with end-stage lung disease. Furthermore, as a therapeutic option for high-risk candidates, single LT (SLT) can be feasible because the immediate morbidity and mortality after transplantation are lower compared to sequential single (double) LT (SSLTx). Still, the long-term overall survival is, in general, better for SSLTx. Despite the great success over the years, the early post-SLT period remains a perilous time for these patients. Patients who undergo SLT are predisposed to evolving early or late postoperative complications. This review emphasizes factors leading to post-SLT complications in the early and late periods including primary graft dysfunction and chronic lung allograft dysfunction, native lung complications, anastomosis complications, infections, cardiovascular, gastrointestinal, renal, and metabolite complications, and their association with morbidity and mortality in these patients. Furthermore, we discuss the incidence of malignancy after SLT and their correlation with immunosuppression therapy.
Core Tip: Improvement in surgical techniques and adequate intra-and post-operative management significantly increased patients’ short- and long-term survival after a single lung transplant. Conditions such as volume overload, cardiovascular complications, antibody-mediated rejection, aspiration, and/or pneumonia could mimic the lung allograft’s acute dysfunction. However, events related to improved surgical techniques and post-operative control of pulmonary immunogenicity through immunosuppressive therapy are among the reasons leading to the reduction of early mortality and prolonged survival of these patients. Thus, the post-operative management after single lung transplantation has to be multidisciplinary and complex.
