Postoperative Management of Hyperinflated Native Lung in Single-Lung Transplant Recipients with Chronic Obstructive Pulmonary Disease: A Review Article

• Published in: Pulmonary therapy 2021-06, Vol.7 (1), p.37-46
• Main Authors: Shehata, Islam M., Elhassan, Amir, Urits, Ivan, Viswanath, Omar, Seoane, Leonardo, Shappley, Courtney, Kaye, Alan D.
• Format: Article
• Language: English
• Subjects: Family Medicine; General Practice; Internal Medicine; Medicine; Medicine & Public Health; Pharmacoeconomics and Health Outcomes; Pharmacotherapy; Pneumology/Respiratory System; Quality of Life Research; Review
• ISSN: 2364-1754; 2364-1746
• DOI: 10.1007/s41030-020-00141-6

End-stage chronic obstructive pulmonary disease (COPD) is the most common indication for single- or double-lung transplantation. Acute native lung hyperinflation (ANLH) is a unique postoperative complication of single-lung transplantation for COPD patients, with incidence varying in the medical literature from 15 to 30%. The diagnosis is made radiographically by contralateral mediastinal shift and ipsilateral diaphragmatic flattening. ANLH can deteriorate into hemodynamic instability, and respiratory impairment can result from compression of the allograft, which can precipitate atelectasis, hypoxemia, and hypercapnia, necessitating specific ventilatory intervention or volume reduction surgery. Currently, there is consensus for a therapeutic role of noninvasive positive pressure ventilation (NIPPV) in acute respiratory failure after lung transplantation as a well-tolerated measure to avoid re-intubation. This manuscript presents a concise review on the diagnosis and treatment of ANLH following unilateral lung transplant, along with a management algorithm created by the authors.