Double-lung transplantation

There is no significant association between pre-existing clinical dysfunction and radiological interstitial edema (30). Very severe adult respiratory distress syndrome requiring double lung transplantation has been reported in one patient (32). 

Brichon PY, Barnoud D, Pison C, Perez I, Guignier M. Double lung transplantation for adnlt respiratory distress syndrome after recombinant interlenkin 2. Chest 1993 104(2) 609-10. 

A 29-year-old man received a double lung transplantation for end-stage cystic fibrosis. After uneventful surgery, he was accidentally given ten times the intended dose of ciclosporin (30 instead of 3 mg/kg) and 18 hours later became anuric. His blood ciclosporin concentration was 4100 ng/ml. Hemodialysis was required for 6 weeks. A renal biopsy 7 weeks later showed typical features of acute tubular necrosis and lesions that resembled chronic nephrotoxicity. Renal function was stiU abnormal when he died from another cause 14 weeks after the accidental overdose. 

A 51-year-old man underwent double lung transplantation for pulmonary fibrosis, accidentally received an infusion of ciclosporin 30 mg/hour instead of 3 mg/hour, and 3 hours later had bilateral reactive mydriasis and absence of tendon reflexes. A CT brain scan showed diffuse cerebral edema, and massive intracranial hjrpertension rapidly developed. He died 5 hours later from brainstem compression, and pathological examination showed diffuse cerebral edema with neuronal necrosis. 

Zhao W, Martin AD, Davenport PW (2002) Respiratory-related evoked potentials elicited by inspiratory occlusions in double-lung transplant recipients. J Appl Physiol 93(3) 894-902... 

Patterson GM, Wilson S, Whang JL, et al. Physiologic definitions of obUterative bronchiolitis in heart-lung and double lung transplantation a comparison of the forced expiratory flow between 25% and 75% of the forced vital capacity and forced expiratory volume in one second. J Heart Lung Transplant 1996 15 175-181. 

Parker LA, Novotny DB. Recurrent alveolar proteinosis following double lung transplantation. Chest 1997 111(5) 1457-1458. 

Injury of the phrenic nerve can be caused from stretching or direct instrumentation of the nerve and occurs after double-lung transplantation in up to 40% in different degrees. Paralysis of the diaphragm results in prolonged ventilation time and longer ICU time (Sheridan et al. 1995 Ferdinande et al. 2004). 

Fig. 5.2.4. Transverse CT scan in double-lung transplant recipient with two sequentially performed single-lung transplants. Lungs of different donors in the same patient show different sizes and densities...

Fig. 5.2.6. a Chest radiograph and b in a double-lung transplant recipient. Both modalities show postoperative atelectasis... 

Fig. 5.2.10.TransverseCT scan in double-lung transplant recipient. CT scan shows multiple cavitary lesions corresponding to pneumatoceles after staphylococcal infection...

Fig. 5.2.12. Coronal multiplanar reformation CT section of a double-lung transplantation recipient in inspiration (left) and expiration (right). Whereas lung density in inspiration is normal, expiration shows extensive basal air trapping...

Fig. 5.2.16. Transverse CT section after double-lung transplantation. CT shows extensive cavitation in the right lower lobe following necrotizing pneumonia...

Fig. 5.2.20. Transverse CT section of a double-lung transplant recipient shows a large subcarinal mass suggestive of post transplant lymphoproliferative disease...

Westney GE, Kesten S, De Hoyos A, Chapparro C, Win-ton T, Maurer JR (1996) Aspergillus infection in single and double lung transplant recipients. Transplantation 61 915-919... 

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