Table 1.

Summary of major complications after lung transplant

Complications	Incidence	Time of onset post-transplant	Management
Primary graft dysfunction	10–25%	Within 72 h	Lung-protective ventilation; restrictive fluid management; inhaled nitric oxide; ECMO initiation within 24 h of transplantation; empiric antimicrobials; immunosuppression; supportive [2]
Rejection	17–28%	Highest in the first year
Acute cellular rejection	17.1–28%		Glucocorticoids; antithymocyte globulin; alemtuzumab; total lymphoid radiation; extracorporeal photopheresis [47]
Antibody-mediated rejection	12.5%		Intravenous immunoglobulin; plasmapheresis; rituximab; proteasome inhibitors [49]
Infection	Varies	Immediate and onwards
Donor-derived pathogens (MRSA, Pseudomonas, Enterobacter, MDRO)			Antimicrobials; perioperative antibiotic prophylaxis based on donor lung microbiology; CMV prophylaxis in the case of all but D−/R− cases; possible surgical intervention in severe cases of invasive species leading to dehiscence
Cytomegalovirus
Fungal (Candida, Aspergillus, Cryptococcus neoformans, endemic mycosis, mucormycosis, Scedosporium, Fusarium)
Invasive Aspergillus
Clostridium difficile
Pleural complications	22–34%	Immediate and onwards
Hemothorax	12–18%		Blood transfusions; surgical re-exploration if severe
Empyema	3–8%		Antimicrobial agents; chest tube
Airway complications	15–20%
Bronchial stenosis		Within 9 months	Balloon bronchoplasty; stent placement [11–18]
Bronchial dehiscence		Within 5 weeks	Radiofrequency ablation [19]
Hematologic
Thromboembolism	5–45%	Immediate	Systemic anticoagulation; thrombectomy
Bleeding		Immediate	Re-exploration for source of bleeding, supportive
Pulmonary vascular stenosis	1.8–5.2%	Within 9 days	Stent angioplasty, surgical intervention, re-transplantation [21, 24]
Diaphragm dysfunction	3.2–8.2%		Supportive measures including non-invasive ventilation [27]
Renal dysfunction
Acute kidney injury	64.5–68.8%	Immediate	Supportive care; dialysis
Neurologic	9.2%	Within 2 weeks
Stroke	41% of all neurological complications		Standard stroke care including transesophageal echocardiography and secondary stroke prevention [92–94]
Metabolic encephalopathy	37% of all neurological complications	Immediate	Identify and treat underlying causes, dialysis, reduction of immunosuppression, protein restriction, empiric fluoroquinolone, or macrolide if caused by hyperammonemia [90, 92]
Posterior reversible encephalopathy	Rare		Discontinuation of calcineurin inhibitor; strict blood pressure control [95]
Seizure			Antiepileptics; correction of underlying etiology [97]
Cardiovascular
Arrhythmia	25–35%	2 days	Rate control and anti-arrhythmic agents with specialist consultation; emergent cardioversion if hemodynamically unstable [111]
Vasoplegia	32%	Immediate	Vasoactive agents; glucocorticoids; supportive care [112]