Lung Transplantation: Perioperative Pharmacology and Anesthetic Considerations
Eduardo S. Rodrigues, Harish Ramakrishna and Octavio E. Pajaro
Affiliation: Department of Anesthesiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224.
In the past two decades, lung transplantation has become an increasingly important
surgical option for the patient with end stage lung disease. Compared with the other solid organ
transplants (heart, liver and kidney), lung transplantation carries immense clinical and logistic
challenges; long-term organ viability is particularly problematic, with an expected five-year
mortality of 40-50%. The number of lung transplants performed in the U.S. has been increasing
steadily since 1988, when UNOS (United Network for Organ Sharing) started recording statistical
data. In that year, 33 cases of lung transplantation were performed. As of today, a total of 23,815
lung transplants have been performed, and the largest number of yearly lung transplants (n=1,822) was performed in
2009. From appropriate patient selection, to optimal organ selection, surgical procedure, and immediate and long-term
postoperative care, the medical process involves multiple healthcare providers and requires a very well-organized and
committed healthcare system to achieve optimal surgical results. Understanding the pharmacology involved in the care of
the lung transplant patient is of utmost importance to achieve appropriate organ preservation, immunosuppression,
hemodynamic stability, and adequate anesthetic depth, while avoiding drug toxicity and side effects. The purpose of this
review is to summarize the pharmacokinetics and pharmacodynamics of the medications most commonly administered to
this patient population, throughout the perioperative period.
Keywords: Anesthesia, lung transplant, lung transplantation, organ transplantation, pharmacology.
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