Longnecker's Anesthesiology > Part 4. Managing Anesthesia Care > Section E. Specialty Areas of Anesthetic Practice > Chapter 57. Anesthesia for Heart or Lung Transplantation Benjamin A. Kohl, MD, and Joseph S. Savino, MD

Key Points

"1. All heart and/or lung transplantations are considered emergency operations. As a result, the anesthetic preparation and management should reflect a consideration of the risks inherent in such a patient population.

2. The most common indications for adult cardiac transplantation are ischemic and idiopathic dilated cardiomyopathies. The most common indications for adult lung transplantation are chronic obstructive pulmonary disease (particularly emphysema and ₁-antitrypsin disease) followed by cystic fibrosis.

3. Acute rejection after lung transplantation occurs with greater frequency compared with transplantation of other solid organs, particularly during the first 6 months after surgery. Thus, timely administration of immunosuppressants is believed to be of key importance in lung transplantation.

4. Although immunosuppressant agents have dramatically reduced the incidence of acute rejection after cardiac transplantation, these drugs have been implicated in cardiac allograft vasculopathy, which remains a leading cause of morbidity and mortality among heart transplant recipients.

5. Patients with primary pulmonary hypertension may have an exacerbation and incremental increase in pulmonary vascular resistance caused by anxiety and agitation. Sedation with minimal respiratory depression is the goal in the lung transplantation..."