Intrathoracic organ transplantation has received little attention from the CICM examiners, with the exception of one SAQ ( Question 22 from the first paper of 2009) which asks the candidate to "discuss the clinical issues specific to the heart lung transplant" in a patient with pneumonia.
LITFL have an excellent lung transplant overview, with a focus on ICU-level management.
Additionally, there is a chapter on this topic in Oh's Manual (Ch.102, pp. 1053) put together by Macdonald and Jansz. It offers some blue boxes full of donation criteria, and a series of protocols detailing the exact doses and timings of the immunesuppressant medications and antimicrobial prophylaxis.
A more detailed summary of complications of combined heart and lung transplantation, focusing on the physiological derangements associated with a long-term transpant, is also available. Specifically, the infectious complications of heart-lung transplantation receive some attention in the Infectious Diseases part of the Required Reading section.
The following brief summary is an attempt to synthesise the most memorable points in Oh's Manual together with the pearls offered by LITFL.
Survival rates for lung transplantation:
Notes on lung donation:
Notes on transplantation:
Idiosyncratic features of management:
The patients end up extubated early - 24 hrs post-op
Specific issues of ventilation:
Specific issues in the single-lung recipient:
Primary graft failure
Early surgical complications
Late surgical complications
LITFL produce an amazing reference to an entire issue of Clinics in Chest Med (2011;32:199-416) devoted to lung transplantation. Unfortunately it does not appear to be available in free full text.
Schuurmans, Macé M., Christian Benden, and Ilhan Inci. "Practical approach to early postoperative management of lung transplant recipients." Swiss Med Wkly143 (2013): w13773.
Leal, S., et al. "Early postoperative management of lung transplantation."Minerva anestesiologica (2014).
Hemmert, C., et al. "Imaging of lung transplant complications." Diagnostic and interventional imaging 95.4 (2014): 399-409.
Singh, Harbhej, and Robert F. Bossard. "Perioperative anaesthetic considerations for patients undergoing lung transplantation." Canadian journal of anaesthesia 44.3 (1997): 284-299.
Question 22 from the first paper of 2009 also fields the following references:
Cisneros, J. M., et al. "Pneumonia after heart transplantation: a multiinstitutional study." Clinical infectious diseases 27.2 (1998): 324-331.
Reichenspurner, Hermann, et al. "Stanford experience with obliterative bronchiolitis after lung and heart-lung transplantation." The Annals of thoracic surgery 62.5 (1996): 1467-1473.
Gao, Shao-Zhou, et al. "Accelerated coronary vascular disease in the heart transplant patient: coronary arteriographic findings." Journal of the American College of Cardiology 12.2 (1988): 334-340.
Yusuf, S. A. L. I. M., et al. "Increased sensitivity of the denervated transplanted human heart to isoprenaline both before and after beta-adrenergic blockade."Circulation 75.4 (1987): 696-704.
George, Elisabeth L., et al. "Effect of Positioning on Oxygenation in Single-Lung Transplant Recipients." American Journal of Critical Care 11.1 (2002): 66-75.