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    "textoCompleto" => "<p class="elsevierStylePara">Indications for lung transplantation are clearly defined and surgical technique has been standardized&#46; Risk and incidence of postoperative surgical complications are&#44; however&#44; high and result in a significantly increased mortality&#46; For most serious complications&#44; such as bleeding&#44; vascular stenoses&#44; and bowel perforations&#44; a high level of suspicion and early measures are key steps to reduce mortality <a href="&#35;bib1" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a>&#46;</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Airways complications</span><p class="elsevierStylePara">Incidence of airways complications is 5-15&#37; depending on the series and appears higher in patients receiving transplantation due to infectious diseases &#40;bronchiectasis and cystic fibrosis&#41;&#44; with cultures positive for aggressive microbes such as <span class="elsevierStyleItalic">Pseudomonas</span> and fungi such as <span class="elsevierStyleItalic">Aspergillus&#44; Scedosporium</span>&#44; or <span class="elsevierStyleItalic">Penicillium&#46;</span> In such patients&#44; incidence doubles&#44; risk of bronchial suture dehiscence is higher and management becomes more challenging due to mucosa membrane inflammation and persisting secretions&#46;</p><p class="elsevierStylePara">Additional incriminated factors are good preservation of lung graft&#44; ischemia time&#44; occurrence of hemodynamic instability during surgery&#44; and the need of high doses of amines during postoperative period <a href="&#35;bib2" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a>&#46;</p><p class="elsevierStylePara">The following complications are observed&#58;</p><ul><li><p class="elsevierStylePara">- Bronchial suture dehiscence</p></li><li><p class="elsevierStylePara">- Bronchial suture stenosis</p></li><li><p class="elsevierStylePara">- Non-suture-related stenosis</p></li><li><p class="elsevierStylePara">- Bronchomalacia</p></li></ul><p class="elsevierStylePara">Suture dehiscence is usually an early complication and results in air leakage through chest drains or in pneumothorax and subcutaneous emphysema when drains have already been removed&#46; It is due to poor healing &#40;remember bronchial vasculature is sectioned during surgery&#41;&#44; particularly when an associated infection is present&#46; Diagnosis is based on bronchoscopy&#44; although multisection CT is also very useful and provides 2D and 3D reconstructions&#46; For small dehiscences &#40;smaller than 1&#160;cm&#41;&#44; therapy can be conservative&#44; with chest drains being left in place and aspiration bronchoscopies being performed&#44; along with appropriate antibiotic and antifungal therapy when needed&#46; Repeated bronchoscopies allow not only clear airways to be maintained but also the healing course to be monitored&#46; For major or very early fistulas after surgery&#44; surgical repair is recommended&#44; using a repeated bronchial suture and a plasty based on adjacent well-vascularized tissue&#46; When a poor condition of donor bronchial tissue is present&#44; and in patients receiving double-lung grafts&#44; right upper lobectomy followed by reanastomosis of donor&#39;s intermediate bronchus to receptor&#39;s main right bronchus is also possible&#46; In left side transplantation&#44; a longer bronchus usually allows bronchial tissue to be sectioned more proximally in a region showing a better condition <a href="&#35;bib3" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a>&#46;</p><p class="elsevierStylePara">Bronchial suture stenoses usually have a later appearance and are due to abnormal healing&#46; Most of them occur after 2 to 3 months&#46; Most common presentation is a non-significant stenosis found during follow-up bronchoscopies or CTs&#59; occasionally stenoses are purely secondary to a size discordance between donor&#39;s bronchus and receptor&#39;s bronchus&#46; In such cases&#44; follow-up to monitor stenosis course is used&#46; In symptomatic patients having stenoses that result in a compromised bronchial lumen &#40;&#62;50&#37;&#41;&#44; therapy is based on balloon dilation and removal of any existing abnormal healing tissue&#59; intercurrent infections should be ruled out or treated&#46; When stenoses recur after 3-4 dilations&#44; an endobronchial stent implant should be used&#46; Based on our experienced we favor autoexpansible bare metallic stents &#40;Ultraflex<span class="elsevierStyleSup">&#174;</span>&#41;&#44; which are implanted under general anesthesia and laryngeal mask&#44; using flexible bronchoscopy and under fluoroscopic monitoring <a href="&#35;bib4" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a>&#46;</p><p class="elsevierStylePara">Multisection CT with 2D and 3D reconstructions is very useful to diagnose such bronchial complications&#46; Furthermore&#44; it allows measurements to be obtained for stent implant and a later follow-up not requiring bronchoscopies which are more invasive and bothersome for patients&#46; Sixty-four sections are used&#44; with a fast image acquisition and radiation dose modulation&#46;</p><p class="elsevierStylePara">Non-suture-related stenosis mainly refers to intermediate right bronchus stenoses and lobar bronchial stenoses distal to bronchial suture&#46; Intermediate bronchus stenoses are caused by difficult revascularization in the area due to a thicker bronchial tissue&#44; and are also treated with dilations and stent implants&#46; Distal lobar stenoses are usually secondary to bronchial inflammation or infection&#44; associated to mucosa membrane thickening&#59; thus&#44; besides medical treatment&#44; dilations and bronchoscopic follow-up are also used&#46;</p><p class="elsevierStylePara">Bronchomalacia in transplanted lung is not uncommon&#44; and results in a dynamic stenosis and cough&#59; diagnosis is achieved bronchoscopically&#46; Symptomatic patients showing an impact on spirometric measurements can be treated with repeated dilations and&#47;or several bronchial stents&#46; Some patients show a progressive and eventually lethal course <a href="&#35;bib5" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a>&#46;</p><p class="elsevierStylePara"><a href="&#35;f0005" class="elsevierStyleCrossRefs">Figure 1</a>&#44; <a href="&#35;f0010" class="elsevierStyleCrossRefs">Figure 2</a></p><a name="f0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="420v21n01-90385614fig1.jpg" alt="CT image showing a bronchial dehiscence in posterior aspect of a left bronchial suture after double-lung transplantation&#46;"></img></p><p class="elsevierStylePara">Figure 1&#46; CT image showing a bronchial dehiscence in posterior aspect of a left bronchial suture after double-lung transplantation&#46;</p><a name="f0010" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="420v21n01-90385614fig2.jpg" alt="Multisection CT with 3D reconstruction showing a stenosis distal to right bronchial suture in double-lung transplantation&#46;"></img></p><p class="elsevierStylePara">Figure 2&#46; Multisection CT with 3D reconstruction showing a stenosis distal to right bronchial suture in double-lung transplantation&#46;</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Vascular complications</span><p class="elsevierStylePara">Vascular complications are less common&#44; and are found in 1-3&#37; of lung transplants&#46; However&#44; mortality associated to such complications is high&#46;</p><p class="elsevierStylePara">Venous suture complications include pulmonary vein stenosis and thrombosis&#46; Lower veins&#44; and particular left lower vein&#44; are more commonly involved&#44; due to their anatomical disposition&#46; A higher incidence in women with pulmonary fibrosis has been reported in literature&#59; this is probably related to a smaller chest cage size&#46; Appropriate auricular cuff size in donor&#39;s lung allowing a wide and less thrombogenic suture to be performed&#44; is very important&#46;</p><p class="elsevierStylePara">Pulmonary vein obstruction is usually an early complication&#44; occurring during the first few hours after transplantation&#44; and causes severe symptoms&#46; Marked hypoxia&#44; pulmonary edema&#44; and pulmonary infiltrates are observed&#46; If the lower lobe is more severely affected&#44; a high suspicion for such a complication is warranted&#44; and an early additional diagnostic test should be ordered&#46; The initial test should be a transthoracic or transesophageal echocardiogram&#44; in spite of this test being only useful for diagnosis when performed by an experienced operator&#44; due to a challenging visualization and interpretation after recent surgery <a href="&#35;bib6" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a>&#46; Alternatively&#44; chest CT angiography can be used&#44; which also allows artery suture and distal vascularization to be assessed and reconstructions to be produced&#46; CT angiography establishes the diagnosis in most cases&#46; Anticoagulation using heparin and clinical course monitoring is used to manage partial thromboses and stenoses&#46; In the event of a complete vein obstruction or a poor course&#44; in patients with a very recent surgery&#44; re-transplantation or lobectomy for double-lung transplantations&#44; may be needed&#46; If the patient is in a stable condition&#44; several days have elapsed&#44; and anatomic characteristics are favorable&#44; an angioplasty with dilation and stent implant can be considered&#46;</p><p class="elsevierStylePara">Arterial suture complications are usually less common and are found later&#46; They result in persistent hypoxia and pulmonary hypertension&#46; Diagnosis is based on CT angiography and&#47;or arteriography&#46; Some degree of arterial suture stenosis with no clinical significance is commonly found in CT angiography&#44; due to donor-receptor size discordance or to the suture itself&#46; Significant stenoses are due to kinking or thrombosis at the suture level&#46; The former are usually treated win angioplasty and dilation&#44; whereas usual therapy for the latter is stent implant if required&#46; Anticoagulation is used for thrombotic cases <a href="&#35;bib7" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a>&#46;</p><p class="elsevierStylePara">Both re-transplantation and intervention techniques on vascular sutures after lung transplantation result in a high mortality rate&#44; even in expert hands&#46; Prognosis depends on early diagnosis and selection of the most appropriate therapy&#44; depending on the complication&#44; time elapsed after transplantation&#44; and clinical condition <a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a>&#46;</p><p class="elsevierStylePara"><a href="&#35;f0015" class="elsevierStyleCrossRefs">Figure 3</a>&#44; <a href="&#35;f0020" class="elsevierStyleCrossRefs">Figure 4</a></p><a name="f0015" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="420v21n01-90385614fig3.jpg" alt="Coronal view in CT angiography showing complete lower pulmonary vein obstruction after left lung transplantation&#46;"></img></p><p class="elsevierStylePara">Figure 3&#46; Coronal view in CT angiography showing complete lower pulmonary vein obstruction after left lung transplantation&#46;</p><a name="f0020" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="420v21n01-90385614fig4.jpg" alt="CT image showing extensive lung infiltrates in lower left lobe resulting from lower pulmonary vein obstruction&#46;"></img></p><p class="elsevierStylePara">Figure 4&#46; CT image showing extensive lung infiltrates in lower left lobe resulting from lower pulmonary vein obstruction&#46;</p><a name="sec0015" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Pleural complications</span><p class="elsevierStylePara">Hemothorax is the most common complication after lung transplant and the one more commonly requiring additional surgical procedures&#46; Hemothoraces may appear either early&#44; a few days after the transplant procedure&#44; or some weeks later&#46; They are rarely due to bleeding from vascular sutures&#59; the main cause is bleeding from divided pleural adhesions&#46; Factors associated to such complications include firm pleuropulmonary adhesions with&#47;without pachypleuritis &#40;patients with bronchiectasis&#44; silicosis&#44; tuberculosis sequelae&#41;&#44; previous surgery &#40;particularly talc pleurodesis&#41;&#44; use of bypass circulation during transplant procedure&#44; and patients requiring pretransplant anticoagulant or antiplatelet therapy&#46; 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both in emphysema and pulmonary fibrosis&#46;</p><p class="elsevierStylePara">In patients receiving single-lung transplantation to treat emphysema&#44; hyperinflation in native lung with mediastinal compression&#44; or even in transplanted lung&#44; may occur&#46; To prevent such events&#44; early extubation is recommended for such patients&#46; We attempt extubation in the operation room after surgery&#46;</p><p class="elsevierStylePara">Chylothorax is uncommon&#46; It is usually due to thoracic duct injuries&#44; particularly at a subcarinal level&#44; when lymphadenopaties have been removed in the region&#46; An appropriate diet with chest drains being kept in place is usually enough to achieve chylothorax resolution&#46;</p><a name="sec0020" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Surgical wound complications</span><p class="elsevierStylePara">Wound complications are uncommon&#46; In patients receiving single-lung transplantation&#44; a partial thoracotomy dehiscence may occur&#44; particularly in obese patients and in patients receiving high-dose steroids before transplantation &#40;pulmonary fibrosis&#41;&#46; Therapy includes compression for small dehiscences and an early re-operation for larger ones and for dehiscences with an impact on cough and respiratory mechanics&#46;</p><p class="elsevierStylePara">In patients receiving double-lung transplants&#44; a dehiscence of transverse sternotomy may occur&#44; particularly in patients with emphysema and a significantly distended thorax&#46; A careful sternum closure using 2 wire double stitches can prevent such complications&#46;</p><p class="elsevierStylePara">Surgical wound hematoma is usually due to bleeding from small muscle vessels having been sectioned&#44; and is more common in patients receiving antiplatelet or anticoagulant therapy before transplant&#46; Therapy includes pressure dressing&#59; only significantly sized hematomas require drainage to prevent later complications&#46;</p><p class="elsevierStylePara">Surgical wound sepsis is uncommon&#44; in spite of such patients being immunodepressed&#46; Surgical debridement is only required when deep layers are involved&#46;</p><p class="elsevierStylePara"><a href="&#35;f0025" class="elsevierStyleCrossRefs">Figure 5</a></p><a name="f0025" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="420v21n01-90385614fig5.jpg" alt="CT coronal section showing left thoracotomy dehiscence after left single-lung transplantation&#46;"></img></p><p class="elsevierStylePara">Figure 5&#46; CT coronal section showing left thoracotomy dehiscence after left single-lung transplantation&#46;</p><a name="sec0025" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Nerve injuries</span><p class="elsevierStylePara">Phrenic&#44; recurrent&#44; and vagus nerves can be injured during transplantation procedure&#46;</p><p class="elsevierStylePara">Phrenic nerve injury is the most serious and the one having the largest impact on cough capacity and respiratory mechanics&#46; It can challenge and delay extubation&#46; High-risk patients include those having firm pleuropulmonary adhesions to mediastinum &#40;bronchiectasis&#44; silicosis&#41;&#46; It can also occur in patients receiving double-lung transplant&#44; due to mediastinal tissue pulling with most cases being eventually reversible&#46;</p><p class="elsevierStylePara">Recurrent nerve injuries usually occur in left side when lymphadenopaties in aortopulmonary window have to be removed to allow lung artery suture &#40;silicosis&#44; sarcoidosis&#41;&#46; It causes vocal cords paralysis with dysphonia and risk for bronchial aspiration due to inadequate glottis closure&#46; Nevertheless&#44; this is usually compensated within a few weeks&#46;</p><p class="elsevierStylePara">Vagus nerve injuries can occur when firm pleuropulmonary adhesions or pachypleuritis are present in posterior mediastinum and thorax&#44; which is typical in patients having bronchiectasis and repeated pneumonia episodes before transplantation&#46; Vagus nerve damage impairs gastric and intestinal motility&#44; particularly when a bilateral injury is present&#46;</p><a name="sec0030" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Abdominal complications</span><p class="elsevierStylePara">Abdominal complications are common and are the leading cause for extra-thoracic surgical complications&#46; In some series&#44; postoperative emergency abdominal surgery incidence after lung transplantation is as high as 8-10&#37;&#46;</p><p class="elsevierStylePara">Paralytic ileus is very common &#40;30-50&#37;&#41; and may show a varying severity&#46; This is due to prolonged operative time&#44; use of postoperative epidural analgesia&#44; immunosupressive drugs&#44; and water-electrolyte balance impairment&#46; Abdominal distension and tympany result in raised diaphragm with respiratory mechanics and cough efficacy being impaired&#46; Therapy includes NPO diet to maintain gastrointestinal rest&#44; adjusting medication and hydration whenever possible&#44; until bowel peristalsis recovers&#46; Most patients show a good clinical course in a few days&#46;</p><p class="elsevierStylePara">Gastroparesia is usually related to drug therapy and can be worsened by vagus nerve injuries resulting from surgery&#46; Occasionally&#44; gastroparesia can be persistent&#44; with recurrent vomiting due to retained undigested food in stomach&#44; which shows a poor response to medical treatment&#46;</p><p class="elsevierStylePara">Acute cholecystitis is common&#44; usually appearing lately in postoperative course&#46; Cholelithiasis is a common finding in candidates to lung transplantation&#46; Clinical course can be insidious because patients may be receiving intravenous analgesia or due to a misdiagnosis resulting from other abdominal clinical pictures&#46; Delayed diagnosis is common and a risk for biliary peritonitis and septicemia exists&#46; A diagnosis suspicion should lead to emergency abdominal ultrasonography or CT&#44; and a prompt cholecistectomy&#46;</p><p class="elsevierStylePara">Nonetheless&#44; bowel perforations are undoubtedly the abdominal complications resulting in highest mortality rates and most commonly requiring postoperative emergency abdominal surgery after lung transplantation&#46; They are more common in right-side colon&#44; particularly in cecum&#44; due to wall ischemia and local perforation resulting from overdistended colon&#46; Fecal peritonitis occurs&#44; resulting in acute abdomen&#44; hemodynamic instability and fast progression to septic shock&#46; An emergency operation is required for perforated region removal and abdominal cavity washing&#46; External ostomies should be used for both bowel ends&#46; Mortality rates due to such complication amount to 50&#37;<a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a>&#46;</p><a name="sec0035" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStylePara">In spite of an appropriate selection of lung transplantation receptors and a careful surgical technique&#44; multiple postoperative complications occur&#44; some of them being serious and resulting in a high mortality rate&#46;</p><p class="elsevierStylePara">Immunosuppressive therapy development&#44; use of correct antibiotic therapy protocols&#44; and improved care and support to transplanted patients in Postoperative Recovery Units have contributed to an improved clinical course and survival in patients with complications <a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a>&#46;</p><p class="elsevierStylePara">A multidisciplinary management and health workers experience are essential for a coordinated and early therapy in such patients&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Note&#58;</span> This is a review and opinion article based on the 15-year experience of the Lung Transplant Program at University Hospital of A Coru&#241;a&#44; covering 450 lung transplantation procedures with an average number of 40 per year in the last 5 years&#46;</p><a name="sec0040" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara">Received 15 September 2014 <br></br>Accepted 15 September 2014 </p><p class="elsevierStylePara">Corresponding author&#46; mtorre&#64;canalejo&#46;org</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle"> Abstract</span><br/><p class="elsevierStylePara"> This is a review article on the main postoperative complications after lung transplantation&#58; airways complications&#44; vascular complications&#44; pleural complications&#44; surgical wound complications&#44; and abdominal complications&#46;</p><p class="elsevierStylePara"> Incidence data&#44; severity&#44; and major management regimens are reported&#46;</p><p class="elsevierStylePara"> Postoperative complications after lung transplantation result in a significantly increased morbidity and mortality&#44; with early diagnosis and therapy being extremely important&#46;</p>"
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      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "The Registry of the International Society for Heart and Lung Transplantation: Thietieth adult lung and heart&#x002D;lung transplant report&#x002D;2013; focus theme: age). J Heart Lung Transplant. 2013; 32(10):965&#x002D;78."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "The Registry of the International Society for Heart and Lung Transplantation&#58; Thietieth adult lung and heart-lung transplant report-2013&#59; focus theme&#58; age&#41;&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:11 [
                            0 => "Yusen RD"
                            1 => "Christie JD"
                            2 => "Edwards LB"
                            3 => "Kucheryavaya AY"
                            4 => "Benden C"
                            5 => "Dipchand AI"
                            6 => "Dobbels F"
                            7 => "Kirk R"
                            8 => "Lund LH"
                            9 => "Rahmel AO"
                            10 => "Stehlik J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.healun.2013.08.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Heart Lung Transplant. "
                        "fecha" => "2013"
                        "volumen" => "32"
                        "paginaInicial" => "965"
                        "paginaFinal" => "978"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24054805"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Risk factors for airway complications within the first year after lung transplantation. Eur J Cardiothorac Surg. 2007; 31:703&#x002D;10."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Risk factors for airway complications within the first year after lung transplantation&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Van De Wauwer C"
                            1 => "Van Raemdonck D"
                            2 => "Verleden GM"
                            3 => "Dupont L"
                            4 => "De Leyn P"
                            5 => "Coosemans W&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejcts.2007.01.025"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg. "
                        "fecha" => "2007"
                        "volumen" => "31"
                        "paginaInicial" => "703"
                        "paginaFinal" => "710"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17306556"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Incidence, management and clinical outcomes of patients with airway complications following lung transplantion. Eur J Cardiothorac Surg. 2008; 34:1198&#x002D;2005."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Incidence&#44; management and clinical outcomes of patients with airway complications following lung transplantion&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Moreno P"
                            1 => "Alv&#225;rez A"
                            2 => "Algar FJ"
                            3 => "Espinosa D"
                            4 => "Cerezo F&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejcts.2008.08.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg. "
                        "fecha" => "2008"
                        "volumen" => "34"
                        "paginaInicial" => "1198"
                        "paginaFinal" => "2005"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18824370"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Tratamiento de complicaciones en la vía aérea postrasplante pulmonar. Arch Bronconeumol. 2011; 47(3):128&#x002D;33."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Tratamiento de complicaciones en la v&#237;a a&#233;rea postrasplante pulmonar&#46;"
                      "idioma" => "es"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Fern&#225;ndez- Bussy S"
                            1 => "Majid A"
                            2 => "Caviedes I"
                            3 => "Akindipe MB"
                            4 => "Jantz M&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2010.10.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol. "
                        "fecha" => "2011"
                        "volumen" => "47"
                        "paginaInicial" => "128"
                        "paginaFinal" => "133"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21334127"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Airway complications and management after lung transplantation: ischemia, dehiscence adn estenosis. Proc Am Thorac Soc. 2009; 6:79&#x002D;93."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Airway complications and management after lung transplantation&#58; ischemia&#44; dehiscence adn estenosis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Santacruz JF"
                            1 => "Metha AC&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1513/pats.200808-094GO"
                      "Revista" => array:6 [
                        "tituloSerie" => "Proc Am Thorac Soc. "
                        "fecha" => "2009"
                        "volumen" => "6"
                        "paginaInicial" => "79"
                        "paginaFinal" => "93"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19131533"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pulmonary venous obstruction after lung transplantation Diagnostic advantages of transesophageal echocardiografy. Clin Transplant. 2009; 23:975&#x002D;80."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Pulmonary venous obstruction after lung transplantation Diagnostic advantages of transesophageal echocardiografy&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Gonz&#225;lez- Fern&#225;ndez C"
                            1 => "Gonz&#225;lez-Castro A"
                            2 => "Rodr&#237;guez- Borreg&#225;n JC"
                            3 => "L&#243;pez-S&#225;nchez M"
                            4 => "Suberviola B"
                            5 => "Nistal F&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1399-0012.2009.01078.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Transplant. "
                        "fecha" => "2009"
                        "volumen" => "23"
                        "paginaInicial" => "975"
                        "paginaFinal" => "980"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19732099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Vascular anastomotic complications in lung transplantation: a single institution's experience. Interact Cardiovasc Thorac Surg. 2013; 17:625&#x002D;31."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Vascular anastomotic complications in lung transplantation&#58; a single institution&#39;s experience&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:9 [
                            0 => "Siddique A"
                            1 => "Bose AK"
                            2 => "&#214;zalp F"
                            3 => "Butt TA"
                            4 => "Muse H"
                            5 => "Morley KE"
                            6 => "Dark JH"
                            7 => "Parry G"
                            8 => "Clark S&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/icvts/ivt266"
                      "Revista" => array:6 [
                        "tituloSerie" => "Interact Cardiovasc Thorac Surg. "
                        "fecha" => "2013"
                        "volumen" => "17"
                        "paginaInicial" => "625"
                        "paginaFinal" => "631"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23788195"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Balloon angioplasty for pulmonary artery stenosis after lung transplantation. Eur J Cardiothorac Surg. 2008; 34:693&#x002D;4."
                  "contribucion" => array:1 [
                    0 => array:3 [
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                  "referenciaCompleta" => "The impact of abdominal complications on the outcome after thoracic transplantation, a single center experience. Langenbecks Arch Surg. 2014; 14:1193&#x002D;7."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "The impact of abdominal complications on the outcome after thoracic transplantation&#44; a single center experience&#46;"
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                          "etal" => false
                          "autores" => array:7 [
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                            2 => "Kleine M"
                            3 => "Warnecke G"
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                            5 => "Lehner F"
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                      ]
                    ]
                  ]
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                0 => array:3 [
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                  "contribucion" => array:1 [
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                        0 => array:2 [
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                            3 => "Canela M"
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                            6 => "Varela A"
                            7 => "Zurbano F"
                            8 => "Mons R"
                            9 => "Morales P"
                            10 => "Pastor J"
                            11 => "Salvatierra A"
                            12 => "De Pablo A"
                            13 => "Moreno A"
                            14 => "Sol&#233; J"
                            15 => "Rom&#225;n A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
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                      "Revista" => array:6 [
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                        "volumen" => "49"
                        "paginaInicial" => "70"
                        "paginaFinal" => "78"
                        "link" => array:1 [
                          0 => array:2 [
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Postoperative surgical complications after lung transplantation
M.. de la Torrea,
Corresponding author
mtorre@canalejo.org

Corresponding author. mtorre@canalejo.org
, R.. Fernándeza, E.. Fieiraa, D.. Gonzáleza, M.. Delgadoa, L.. Méndeza, J.M.. Borroa
a Department of Thoracic Surgery and Lung Transplantation, University Hospital of A Coruña, A Coruña, Spain
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    "textoCompleto" => "<p class="elsevierStylePara">Indications for lung transplantation are clearly defined and surgical technique has been standardized&#46; Risk and incidence of postoperative surgical complications are&#44; however&#44; high and result in a significantly increased mortality&#46; For most serious complications&#44; such as bleeding&#44; vascular stenoses&#44; and bowel perforations&#44; a high level of suspicion and early measures are key steps to reduce mortality <a href="&#35;bib1" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a>&#46;</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Airways complications</span><p class="elsevierStylePara">Incidence of airways complications is 5-15&#37; depending on the series and appears higher in patients receiving transplantation due to infectious diseases &#40;bronchiectasis and cystic fibrosis&#41;&#44; with cultures positive for aggressive microbes such as <span class="elsevierStyleItalic">Pseudomonas</span> and fungi such as <span class="elsevierStyleItalic">Aspergillus&#44; Scedosporium</span>&#44; or <span class="elsevierStyleItalic">Penicillium&#46;</span> In such patients&#44; incidence doubles&#44; risk of bronchial suture dehiscence is higher and management becomes more challenging due to mucosa membrane inflammation and persisting secretions&#46;</p><p class="elsevierStylePara">Additional incriminated factors are good preservation of lung graft&#44; ischemia time&#44; occurrence of hemodynamic instability during surgery&#44; and the need of high doses of amines during postoperative period <a href="&#35;bib2" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a>&#46;</p><p class="elsevierStylePara">The following complications are observed&#58;</p><ul><li><p class="elsevierStylePara">- Bronchial suture dehiscence</p></li><li><p class="elsevierStylePara">- Bronchial suture stenosis</p></li><li><p class="elsevierStylePara">- Non-suture-related stenosis</p></li><li><p class="elsevierStylePara">- Bronchomalacia</p></li></ul><p class="elsevierStylePara">Suture dehiscence is usually an early complication and results in air leakage through chest drains or in pneumothorax and subcutaneous emphysema when drains have already been removed&#46; It is due to poor healing &#40;remember bronchial vasculature is sectioned during surgery&#41;&#44; particularly when an associated infection is present&#46; Diagnosis is based on bronchoscopy&#44; although multisection CT is also very useful and provides 2D and 3D reconstructions&#46; For small dehiscences &#40;smaller than 1&#160;cm&#41;&#44; therapy can be conservative&#44; with chest drains being left in place and aspiration bronchoscopies being performed&#44; along with appropriate antibiotic and antifungal therapy when needed&#46; Repeated bronchoscopies allow not only clear airways to be maintained but also the healing course to be monitored&#46; For major or very early fistulas after surgery&#44; surgical repair is recommended&#44; using a repeated bronchial suture and a plasty based on adjacent well-vascularized tissue&#46; When a poor condition of donor bronchial tissue is present&#44; and in patients receiving double-lung grafts&#44; right upper lobectomy followed by reanastomosis of donor&#39;s intermediate bronchus to receptor&#39;s main right bronchus is also possible&#46; In left side transplantation&#44; a longer bronchus usually allows bronchial tissue to be sectioned more proximally in a region showing a better condition <a href="&#35;bib3" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a>&#46;</p><p class="elsevierStylePara">Bronchial suture stenoses usually have a later appearance and are due to abnormal healing&#46; Most of them occur after 2 to 3 months&#46; Most common presentation is a non-significant stenosis found during follow-up bronchoscopies or CTs&#59; occasionally stenoses are purely secondary to a size discordance between donor&#39;s bronchus and receptor&#39;s bronchus&#46; In such cases&#44; follow-up to monitor stenosis course is used&#46; In symptomatic patients having stenoses that result in a compromised bronchial lumen &#40;&#62;50&#37;&#41;&#44; therapy is based on balloon dilation and removal of any existing abnormal healing tissue&#59; intercurrent infections should be ruled out or treated&#46; When stenoses recur after 3-4 dilations&#44; an endobronchial stent implant should be used&#46; Based on our experienced we favor autoexpansible bare metallic stents &#40;Ultraflex<span class="elsevierStyleSup">&#174;</span>&#41;&#44; which are implanted under general anesthesia and laryngeal mask&#44; using flexible bronchoscopy and under fluoroscopic monitoring <a href="&#35;bib4" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a>&#46;</p><p class="elsevierStylePara">Multisection CT with 2D and 3D reconstructions is very useful to diagnose such bronchial complications&#46; Furthermore&#44; it allows measurements to be obtained for stent implant and a later follow-up not requiring bronchoscopies which are more invasive and bothersome for patients&#46; Sixty-four sections are used&#44; with a fast image acquisition and radiation dose modulation&#46;</p><p class="elsevierStylePara">Non-suture-related stenosis mainly refers to intermediate right bronchus stenoses and lobar bronchial stenoses distal to bronchial suture&#46; Intermediate bronchus stenoses are caused by difficult revascularization in the area due to a thicker bronchial tissue&#44; and are also treated with dilations and stent implants&#46; Distal lobar stenoses are usually secondary to bronchial inflammation or infection&#44; associated to mucosa membrane thickening&#59; thus&#44; besides medical treatment&#44; dilations and bronchoscopic follow-up are also used&#46;</p><p class="elsevierStylePara">Bronchomalacia in transplanted lung is not uncommon&#44; and results in a dynamic stenosis and cough&#59; diagnosis is achieved bronchoscopically&#46; Symptomatic patients showing an impact on spirometric measurements can be treated with repeated dilations and&#47;or several bronchial stents&#46; Some patients show a progressive and eventually lethal course <a href="&#35;bib5" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a>&#46;</p><p class="elsevierStylePara"><a href="&#35;f0005" class="elsevierStyleCrossRefs">Figure 1</a>&#44; <a href="&#35;f0010" class="elsevierStyleCrossRefs">Figure 2</a></p><a name="f0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="420v21n01-90385614fig1.jpg" alt="CT image showing a bronchial dehiscence in posterior aspect of a left bronchial suture after double-lung transplantation&#46;"></img></p><p class="elsevierStylePara">Figure 1&#46; CT image showing a bronchial dehiscence in posterior aspect of a left bronchial suture after double-lung transplantation&#46;</p><a name="f0010" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="420v21n01-90385614fig2.jpg" alt="Multisection CT with 3D reconstruction showing a stenosis distal to right bronchial suture in double-lung transplantation&#46;"></img></p><p class="elsevierStylePara">Figure 2&#46; Multisection CT with 3D reconstruction showing a stenosis distal to right bronchial suture in double-lung transplantation&#46;</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Vascular complications</span><p class="elsevierStylePara">Vascular complications are less common&#44; and are found in 1-3&#37; of lung transplants&#46; However&#44; mortality associated to such complications is high&#46;</p><p class="elsevierStylePara">Venous suture complications include pulmonary vein stenosis and thrombosis&#46; Lower veins&#44; and particular left lower vein&#44; are more commonly involved&#44; due to their anatomical disposition&#46; A higher incidence in women with pulmonary fibrosis has been reported in literature&#59; this is probably related to a smaller chest cage size&#46; Appropriate auricular cuff size in donor&#39;s lung allowing a wide and less thrombogenic suture to be performed&#44; is very important&#46;</p><p class="elsevierStylePara">Pulmonary vein obstruction is usually an early complication&#44; occurring during the first few hours after transplantation&#44; and causes severe symptoms&#46; Marked hypoxia&#44; pulmonary edema&#44; and pulmonary infiltrates are observed&#46; If the lower lobe is more severely affected&#44; a high suspicion for such a complication is warranted&#44; and an early additional diagnostic test should be ordered&#46; The initial test should be a transthoracic or transesophageal echocardiogram&#44; in spite of this test being only useful for diagnosis when performed by an experienced operator&#44; due to a challenging visualization and interpretation after recent surgery <a href="&#35;bib6" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a>&#46; Alternatively&#44; chest CT angiography can be used&#44; which also allows artery suture and distal vascularization to be assessed and reconstructions to be produced&#46; CT angiography establishes the diagnosis in most cases&#46; Anticoagulation using heparin and clinical course monitoring is used to manage partial thromboses and stenoses&#46; In the event of a complete vein obstruction or a poor course&#44; in patients with a very recent surgery&#44; re-transplantation or lobectomy for double-lung transplantations&#44; may be needed&#46; If the patient is in a stable condition&#44; several days have elapsed&#44; and anatomic characteristics are favorable&#44; an angioplasty with dilation and stent implant can be considered&#46;</p><p class="elsevierStylePara">Arterial suture complications are usually less common and are found later&#46; They result in persistent hypoxia and pulmonary hypertension&#46; Diagnosis is based on CT angiography and&#47;or arteriography&#46; Some degree of arterial suture stenosis with no clinical significance is commonly found in CT angiography&#44; due to donor-receptor size discordance or to the suture itself&#46; Significant stenoses are due to kinking or thrombosis at the suture level&#46; The former are usually treated win angioplasty and dilation&#44; whereas usual therapy for the latter is stent implant if required&#46; Anticoagulation is used for thrombotic cases <a href="&#35;bib7" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a>&#46;</p><p class="elsevierStylePara">Both re-transplantation and intervention techniques on vascular sutures after lung transplantation result in a high mortality rate&#44; even in expert hands&#46; Prognosis depends on early diagnosis and selection of the most appropriate therapy&#44; depending on the complication&#44; time elapsed after transplantation&#44; and clinical condition <a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a>&#46;</p><p class="elsevierStylePara"><a href="&#35;f0015" class="elsevierStyleCrossRefs">Figure 3</a>&#44; <a href="&#35;f0020" class="elsevierStyleCrossRefs">Figure 4</a></p><a name="f0015" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="420v21n01-90385614fig3.jpg" alt="Coronal view in CT angiography showing complete lower pulmonary vein obstruction after left lung transplantation&#46;"></img></p><p class="elsevierStylePara">Figure 3&#46; Coronal view in CT angiography showing complete lower pulmonary vein obstruction after left lung transplantation&#46;</p><a name="f0020" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="420v21n01-90385614fig4.jpg" alt="CT image showing extensive lung infiltrates in lower left lobe resulting from lower pulmonary vein obstruction&#46;"></img></p><p class="elsevierStylePara">Figure 4&#46; CT image showing extensive lung infiltrates in lower left lobe resulting from lower pulmonary vein obstruction&#46;</p><a name="sec0015" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Pleural complications</span><p class="elsevierStylePara">Hemothorax is the most common complication after lung transplant and the one more commonly requiring additional surgical procedures&#46; Hemothoraces may appear either early&#44; a few days after the transplant procedure&#44; or some weeks later&#46; They are rarely due to bleeding from vascular sutures&#59; the main cause is bleeding from divided pleural adhesions&#46; Factors associated to such complications include firm pleuropulmonary adhesions with&#47;without pachypleuritis &#40;patients with bronchiectasis&#44; silicosis&#44; tuberculosis sequelae&#41;&#44; previous surgery &#40;particularly talc pleurodesis&#41;&#44; use of bypass circulation during transplant procedure&#44; and patients requiring pretransplant anticoagulant or antiplatelet therapy&#46; Therapy includes early re-operation for a surgical review of hemostasis and correction of coagulation abnormalities&#46;</p><p class="elsevierStylePara">Prolonged air leakage through chest drains is uncommon because transplant surgery is quite careful and aerostatic&#46; It can be due to lung damage during removal&#44; particularly when pleural adhesions are present in donor lung or an inadvertent damage is caused by graft handling during implantation or closure&#46; Bronchial suture dehiscence must be ruled out by means of a bronchoscopy&#46; Therapy is usually conservative&#44; with chest drains being kept in place&#46;</p><p class="elsevierStylePara">Pneumothorax is uncommon&#46; It can occur after chest drains removal when a size discordance exist between donor&#39;s graft and receptor with the lung not being large enough to fill the pleural cavity&#59; this may occur in patients with emphysema and a significant pretransplant lung hyperinflation&#46; Pneumothorax can also occur in non-transplanted native lung in patients receiving single-lung transplantation&#44; both in emphysema and pulmonary fibrosis&#46;</p><p class="elsevierStylePara">In patients receiving single-lung transplantation to treat emphysema&#44; hyperinflation in native lung with mediastinal compression&#44; or even in transplanted lung&#44; may occur&#46; To prevent such events&#44; early extubation is recommended for such patients&#46; We attempt extubation in the operation room after surgery&#46;</p><p class="elsevierStylePara">Chylothorax is uncommon&#46; It is usually due to thoracic duct injuries&#44; particularly at a subcarinal level&#44; when lymphadenopaties have been removed in the region&#46; An appropriate diet with chest drains being kept in place is usually enough to achieve chylothorax resolution&#46;</p><a name="sec0020" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Surgical wound complications</span><p class="elsevierStylePara">Wound complications are uncommon&#46; In patients receiving single-lung transplantation&#44; a partial thoracotomy dehiscence may occur&#44; particularly in obese patients and in patients receiving high-dose steroids before transplantation &#40;pulmonary fibrosis&#41;&#46; Therapy includes compression for small dehiscences and an early re-operation for larger ones and for dehiscences with an impact on cough and respiratory mechanics&#46;</p><p class="elsevierStylePara">In patients receiving double-lung transplants&#44; a dehiscence of transverse sternotomy may occur&#44; particularly in patients with emphysema and a significantly distended thorax&#46; A careful sternum closure using 2 wire double stitches can prevent such complications&#46;</p><p class="elsevierStylePara">Surgical wound hematoma is usually due to bleeding from small muscle vessels having been sectioned&#44; and is more common in patients receiving antiplatelet or anticoagulant therapy before transplant&#46; Therapy includes pressure dressing&#59; only significantly sized hematomas require drainage to prevent later complications&#46;</p><p class="elsevierStylePara">Surgical wound sepsis is uncommon&#44; in spite of such patients being immunodepressed&#46; Surgical debridement is only required when deep layers are involved&#46;</p><p class="elsevierStylePara"><a href="&#35;f0025" class="elsevierStyleCrossRefs">Figure 5</a></p><a name="f0025" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="420v21n01-90385614fig5.jpg" alt="CT coronal section showing left thoracotomy dehiscence after left single-lung transplantation&#46;"></img></p><p class="elsevierStylePara">Figure 5&#46; CT coronal section showing left thoracotomy dehiscence after left single-lung transplantation&#46;</p><a name="sec0025" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Nerve injuries</span><p class="elsevierStylePara">Phrenic&#44; recurrent&#44; and vagus nerves can be injured during transplantation procedure&#46;</p><p class="elsevierStylePara">Phrenic nerve injury is the most serious and the one having the largest impact on cough capacity and respiratory mechanics&#46; It can challenge and delay extubation&#46; High-risk patients include those having firm pleuropulmonary adhesions to mediastinum &#40;bronchiectasis&#44; silicosis&#41;&#46; It can also occur in patients receiving double-lung transplant&#44; due to mediastinal tissue pulling with most cases being eventually reversible&#46;</p><p class="elsevierStylePara">Recurrent nerve injuries usually occur in left side when lymphadenopaties in aortopulmonary window have to be removed to allow lung artery suture &#40;silicosis&#44; sarcoidosis&#41;&#46; It causes vocal cords paralysis with dysphonia and risk for bronchial aspiration due to inadequate glottis closure&#46; Nevertheless&#44; this is usually compensated within a few weeks&#46;</p><p class="elsevierStylePara">Vagus nerve injuries can occur when firm pleuropulmonary adhesions or pachypleuritis are present in posterior mediastinum and thorax&#44; which is typical in patients having bronchiectasis and repeated pneumonia episodes before transplantation&#46; Vagus nerve damage impairs gastric and intestinal motility&#44; particularly when a bilateral injury is present&#46;</p><a name="sec0030" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Abdominal complications</span><p class="elsevierStylePara">Abdominal complications are common and are the leading cause for extra-thoracic surgical complications&#46; In some series&#44; postoperative emergency abdominal surgery incidence after lung transplantation is as high as 8-10&#37;&#46;</p><p class="elsevierStylePara">Paralytic ileus is very common &#40;30-50&#37;&#41; and may show a varying severity&#46; This is due to prolonged operative time&#44; use of postoperative epidural analgesia&#44; immunosupressive drugs&#44; and water-electrolyte balance impairment&#46; Abdominal distension and tympany result in raised diaphragm with respiratory mechanics and cough efficacy being impaired&#46; Therapy includes NPO diet to maintain gastrointestinal rest&#44; adjusting medication and hydration whenever possible&#44; until bowel peristalsis recovers&#46; Most patients show a good clinical course in a few days&#46;</p><p class="elsevierStylePara">Gastroparesia is usually related to drug therapy and can be worsened by vagus nerve injuries resulting from surgery&#46; Occasionally&#44; gastroparesia can be persistent&#44; with recurrent vomiting due to retained undigested food in stomach&#44; which shows a poor response to medical treatment&#46;</p><p class="elsevierStylePara">Acute cholecystitis is common&#44; usually appearing lately in postoperative course&#46; Cholelithiasis is a common finding in candidates to lung transplantation&#46; Clinical course can be insidious because patients may be receiving intravenous analgesia or due to a misdiagnosis resulting from other abdominal clinical pictures&#46; Delayed diagnosis is common and a risk for biliary peritonitis and septicemia exists&#46; A diagnosis suspicion should lead to emergency abdominal ultrasonography or CT&#44; and a prompt cholecistectomy&#46;</p><p class="elsevierStylePara">Nonetheless&#44; bowel perforations are undoubtedly the abdominal complications resulting in highest mortality rates and most commonly requiring postoperative emergency abdominal surgery after lung transplantation&#46; They are more common in right-side colon&#44; particularly in cecum&#44; due to wall ischemia and local perforation resulting from overdistended colon&#46; Fecal peritonitis occurs&#44; resulting in acute abdomen&#44; hemodynamic instability and fast progression to septic shock&#46; An emergency operation is required for perforated region removal and abdominal cavity washing&#46; External ostomies should be used for both bowel ends&#46; Mortality rates due to such complication amount to 50&#37;<a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a>&#46;</p><a name="sec0035" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStylePara">In spite of an appropriate selection of lung transplantation receptors and a careful surgical technique&#44; multiple postoperative complications occur&#44; some of them being serious and resulting in a high mortality rate&#46;</p><p class="elsevierStylePara">Immunosuppressive therapy development&#44; use of correct antibiotic therapy protocols&#44; and improved care and support to transplanted patients in Postoperative Recovery Units have contributed to an improved clinical course and survival in patients with complications <a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a>&#46;</p><p class="elsevierStylePara">A multidisciplinary management and health workers experience are essential for a coordinated and early therapy in such patients&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Note&#58;</span> This is a review and opinion article based on the 15-year experience of the Lung Transplant Program at University Hospital of A Coru&#241;a&#44; covering 450 lung transplantation procedures with an average number of 40 per year in the last 5 years&#46;</p><a name="sec0040" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara">Received 15 September 2014 <br></br>Accepted 15 September 2014 </p><p class="elsevierStylePara">Corresponding author&#46; mtorre&#64;canalejo&#46;org</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle"> Abstract</span><br/><p class="elsevierStylePara"> This is a review article on the main postoperative complications after lung transplantation&#58; airways complications&#44; vascular complications&#44; pleural complications&#44; surgical wound complications&#44; and abdominal complications&#46;</p><p class="elsevierStylePara"> Incidence data&#44; severity&#44; and major management regimens are reported&#46;</p><p class="elsevierStylePara"> Postoperative complications after lung transplantation result in a significantly increased morbidity and mortality&#44; with early diagnosis and therapy being extremely important&#46;</p>"
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                0 => array:3 [
                  "referenciaCompleta" => "The Registry of the International Society for Heart and Lung Transplantation: Thietieth adult lung and heart&#x002D;lung transplant report&#x002D;2013; focus theme: age). J Heart Lung Transplant. 2013; 32(10):965&#x002D;78."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "The Registry of the International Society for Heart and Lung Transplantation&#58; Thietieth adult lung and heart-lung transplant report-2013&#59; focus theme&#58; age&#41;&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:11 [
                            0 => "Yusen RD"
                            1 => "Christie JD"
                            2 => "Edwards LB"
                            3 => "Kucheryavaya AY"
                            4 => "Benden C"
                            5 => "Dipchand AI"
                            6 => "Dobbels F"
                            7 => "Kirk R"
                            8 => "Lund LH"
                            9 => "Rahmel AO"
                            10 => "Stehlik J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.healun.2013.08.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Heart Lung Transplant. "
                        "fecha" => "2013"
                        "volumen" => "32"
                        "paginaInicial" => "965"
                        "paginaFinal" => "978"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24054805"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
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              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Risk factors for airway complications within the first year after lung transplantation. Eur J Cardiothorac Surg. 2007; 31:703&#x002D;10."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Risk factors for airway complications within the first year after lung transplantation&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Van De Wauwer C"
                            1 => "Van Raemdonck D"
                            2 => "Verleden GM"
                            3 => "Dupont L"
                            4 => "De Leyn P"
                            5 => "Coosemans W&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejcts.2007.01.025"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg. "
                        "fecha" => "2007"
                        "volumen" => "31"
                        "paginaInicial" => "703"
                        "paginaFinal" => "710"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17306556"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Incidence, management and clinical outcomes of patients with airway complications following lung transplantion. Eur J Cardiothorac Surg. 2008; 34:1198&#x002D;2005."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Incidence&#44; management and clinical outcomes of patients with airway complications following lung transplantion&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Moreno P"
                            1 => "Alv&#225;rez A"
                            2 => "Algar FJ"
                            3 => "Espinosa D"
                            4 => "Cerezo F&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejcts.2008.08.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg. "
                        "fecha" => "2008"
                        "volumen" => "34"
                        "paginaInicial" => "1198"
                        "paginaFinal" => "2005"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18824370"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Tratamiento de complicaciones en la vía aérea postrasplante pulmonar. Arch Bronconeumol. 2011; 47(3):128&#x002D;33."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Tratamiento de complicaciones en la v&#237;a a&#233;rea postrasplante pulmonar&#46;"
                      "idioma" => "es"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Fern&#225;ndez- Bussy S"
                            1 => "Majid A"
                            2 => "Caviedes I"
                            3 => "Akindipe MB"
                            4 => "Jantz M&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2010.10.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol. "
                        "fecha" => "2011"
                        "volumen" => "47"
                        "paginaInicial" => "128"
                        "paginaFinal" => "133"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21334127"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Airway complications and management after lung transplantation: ischemia, dehiscence adn estenosis. Proc Am Thorac Soc. 2009; 6:79&#x002D;93."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Airway complications and management after lung transplantation&#58; ischemia&#44; dehiscence adn estenosis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Santacruz JF"
                            1 => "Metha AC&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1513/pats.200808-094GO"
                      "Revista" => array:6 [
                        "tituloSerie" => "Proc Am Thorac Soc. "
                        "fecha" => "2009"
                        "volumen" => "6"
                        "paginaInicial" => "79"
                        "paginaFinal" => "93"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19131533"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pulmonary venous obstruction after lung transplantation Diagnostic advantages of transesophageal echocardiografy. Clin Transplant. 2009; 23:975&#x002D;80."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Pulmonary venous obstruction after lung transplantation Diagnostic advantages of transesophageal echocardiografy&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            1 => "Gonz&#225;lez-Castro A"
                            2 => "Rodr&#237;guez- Borreg&#225;n JC"
                            3 => "L&#243;pez-S&#225;nchez M"
                            4 => "Suberviola B"
                            5 => "Nistal F&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1399-0012.2009.01078.x"
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                        "tituloSerie" => "Clin Transplant. "
                        "fecha" => "2009"
                        "volumen" => "23"
                        "paginaInicial" => "975"
                        "paginaFinal" => "980"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19732099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Vascular anastomotic complications in lung transplantation: a single institution's experience. Interact Cardiovasc Thorac Surg. 2013; 17:625&#x002D;31."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Vascular anastomotic complications in lung transplantation&#58; a single institution&#39;s experience&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:9 [
                            0 => "Siddique A"
                            1 => "Bose AK"
                            2 => "&#214;zalp F"
                            3 => "Butt TA"
                            4 => "Muse H"
                            5 => "Morley KE"
                            6 => "Dark JH"
                            7 => "Parry G"
                            8 => "Clark S&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/icvts/ivt266"
                      "Revista" => array:6 [
                        "tituloSerie" => "Interact Cardiovasc Thorac Surg. "
                        "fecha" => "2013"
                        "volumen" => "17"
                        "paginaInicial" => "625"
                        "paginaFinal" => "631"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23788195"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Balloon angioplasty for pulmonary artery stenosis after lung transplantation. Eur J Cardiothorac Surg. 2008; 34:693&#x002D;4."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Balloon angioplasty for pulmonary artery stenosis after lung transplantation&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Shoji T"
                            1 => "Hanaoka N"
                            2 => "Wada H"
                            3 => "Bando T&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejcts.2008.06.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg. "
                        "fecha" => "2008"
                        "volumen" => "34"
                        "paginaInicial" => "693"
                        "paginaFinal" => "694"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18639464"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "The impact of abdominal complications on the outcome after thoracic transplantation, a single center experience. Langenbecks Arch Surg. 2014; 14:1193&#x002D;7."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "The impact of abdominal complications on the outcome after thoracic transplantation&#44; a single center experience&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Timrott K"
                            1 => "Vondran FWR"
                            2 => "Kleine M"
                            3 => "Warnecke G"
                            4 => "Haverich A"
                            5 => "Lehner F"
                            6 => "Klempnauer J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Langenbecks Arch Surg. "
                        "fecha" => "2014"
                        "volumen" => "14"
                        "paginaInicial" => "1193"
                        "paginaFinal" => "1197"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rsgistro Español de Trasplante Pulmonar: primer informe de resultados (2006&#x002D;2010). Arch Bronconeumol. 2013; 49(2):70&#x002D;8."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Rsgistro Espa&#241;ol de Trasplante Pulmonar&#58; primer informe de resultados &#40;2006-2010&#41;&#46;"
                      "idioma" => "es"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:16 [
                            0 => "Coll E"
                            1 => "Santos F"
                            2 => "Ussetti P"
                            3 => "Canela M"
                            4 => "Borro JM"
                            5 => "De la Torre M"
                            6 => "Varela A"
                            7 => "Zurbano F"
                            8 => "Mons R"
                            9 => "Morales P"
                            10 => "Pastor J"
                            11 => "Salvatierra A"
                            12 => "De Pablo A"
                            13 => "Moreno A"
                            14 => "Sol&#233; J"
                            15 => "Rom&#225;n A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2012.06.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol. "
                        "fecha" => "2013"
                        "volumen" => "49"
                        "paginaInicial" => "70"
                        "paginaFinal" => "78"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22939738"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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