Int J Angiol 2024; 33(02): 123-127
DOI: 10.1055/s-0044-1786859
Review Article

Pulmonary Embolism Following Lung Transplantation: Prevention and Management

Daniel Mohammadi
1   Department of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky
,
Suresh Keshavamurthy
2   Department of Cardiovascular and Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
› Author Affiliations

Abstract

Thromboembolic events are the third leading cardiovascular diagnosis following stroke and myocardial infarction. In the United States, 300,000 to 600,000 people per year are diagnosed with venous thromboembolism, either deep venous thrombosis or pulmonary embolism (PE). Of those patients, thousands die from PE despite heightened vigilance and improved therapies. Lung transplant recipients are at increased risk of developing PE due to multiple risk factors unique to this population. Additionally, the transplant recipients are more susceptible to morbid complications from PE. As a result, prevention, timely recognition, and intervention of PE in the lung transplant population are of the utmost importance.



Publication History

Article published online:
13 May 2024

© 2024. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 
  • References

  • 1 Emuakhagbon V, Philips P, Agopian V, Kaldas FM, Jones CM. Incidence and risk factors for deep venous thrombosis and pulmonary embolus after liver transplantation. Am J Surg 2016; 211 (04) 768-771
  • 2 Evans CF, Iacono AT, Sanchez PG. et al. Venous thromboembolic complications of lung transplantation: a contemporary single-institution review. Ann Thorac Surg 2015; 100 (06) 2033-2039 , discussion 2039–2040
  • 3 Kahan ES, Petersen G, Gaughan JP, Criner GJ. High incidence of venous thromboembolic events in lung transplant recipients. J Heart Lung Transplant 2007; 26 (04) 339-344
  • 4 Yegen HA, Lederer DJ, Barr RG. et al. Risk factors for venous thromboembolism after lung transplantation. Chest 2007; 132 (02) 547-553
  • 5 Zheng M, Yousef I, Mamary AJ. et al. Venous thromboembolism in lung transplant recipients real world experience from a high volume center. J Heart Lung Transplant 2021; 40 (10) 1145-1152
  • 6 Martin KA, Molsberry R, Cuttica MJ, Desai KR, Schimmel DR, Khan SS. Time trends in pulmonary embolism mortality rates in the United States, 1999 to 2018. J Am Heart Assoc 2020; 9 (17) e016784
  • 7 Kroshus TJ, Kshettry VR, Hertz MI, Bolman III RM. Deep venous thrombosis and pulmonary embolism after lung transplantation. J Thorac Cardiovasc Surg 1995; 110 (02) 540-544
  • 8 Ribeiro Neto ML, Budev M, Culver DA. et al. Venous thromboembolism after adult lung transplantation: a frequent event associated with lower survival. Transplantation 2018; 102 (04) 681-687
  • 9 Terada Y, Gauthier JM, Pasque MK. et al. Clinical outcomes of lung transplants from donors with unexpected pulmonary embolism. Ann Thorac Surg 2021; 112 (02) 387-394
  • 10 DeFreitas MR, McAdams HP, Azfar Ali H, Iranmanesh AM, Chalian H. Complications of lung transplantation: update on imaging manifestations and management. Radiol Cardiothorac Imaging 2021; 3 (04) e190252
  • 11 Keller CA. et al. Pulmonary embolism following lung transplantation: experience after 100 consecutive transplants. Chest 2006; 130 (04) 153S
  • 12 Subramanian MP, Meyers BF. Bilateral versus single lung transplantation: are two lungs better than one?. J Thorac Dis 2018; 10 (07) 4588-4601
  • 13 Krivokuca I, van de Graaf EA, van Kessel DA, van den Bosch JM, Grutters JC, Kwakkel-van Erp JM. Pulmonary embolism and pulmonary infarction after lung transplantation. Clin Appl Thromb Hemost 2011; 17 (04) 421-424
  • 14 Nielsen JD. The incidence of pulmonary embolism during deep vein thrombosis. Phlebology 2013; 28 (Suppl. 01) 29-33
  • 15 Gomez-Abraham JA. et al. (239) - Use of Protek Duo Cannula (RVAD) for percutaneous support in various clinical settings. A safe and effective option. J Heart Lung Transplant 2018; 37 (4, supplement) S102
  • 16 Batra K, Chamarthy MR, Reddick M, Roda MS, Wait M, Kalva SP. Diagnosis and interventions of vascular complications in lung transplant. Cardiovasc Diagn Ther 2018; 8 (03) 378-386
  • 17 Nathan SD, Barnett SD, Urban BA, Nowalk C, Moran BR, Burton N. Pulmonary embolism in idiopathic pulmonary fibrosis transplant recipients. Chest 2003; 123 (05) 1758-1763
  • 18 Martinez Licha CR, McCurdy CM, Maldonado SM, Lee LS. Current management of acute pulmonary embolism. Ann Thorac Cardiovasc Surg 2020; 26 (02) 65-71
  • 19 Rudski LG, Lai WW, Afilalo J. et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010; 23 (07) 685-713 , quiz 786–788
  • 20 Sáez-Giménez B, Berastegui C, Sintes H. et al. Prophylaxis with enoxaparin for prevention of venous thromboembolism after lung transplantation: a retrospective study. Transpl Int 2017; 30 (12) 1266-1274
  • 21 Sofjan AK, Iuppa JA, Bain KB. et al. Evaluation of enoxaparin dosing as a risk factor for bleeding in lung transplant recipients. Ann Pharmacother 2016; 50 (10) 824-831
  • 22 Ahya VN, McShane PJ, Baz MA. et al. Increased risk of venous thromboembolism with a sirolimus-based immunosuppression regimen in lung transplantation. J Heart Lung Transplant 2011; 30 (02) 175-181
  • 23 Ogutur E. et al. Thromboembolism after lung transplantation - prolonged anticoagulation prophylaxis depending on age and body weight?. J Heart Lung Transplant 2022; 41 (4, supplement): S259-S260
  • 24 Hoeper MM, Madani MM, Nakanishi N, Meyer B, Cebotari S, Rubin LJ. Chronic thromboembolic pulmonary hypertension. Lancet Respir Med 2014; 2 (07) 573-582
  • 25 DeCarolis DD, Thorson JG, Clairmont MA, Leuthner AM, Rector TS, Johnson GJ. Enoxaparin outcomes in patients with moderate renal impairment. Arch Intern Med 2012; 172 (22) 1713-1718
  • 26 Kaur J, Arsene C, Yadav SK. et al. Risk factors in hospitalized patients for heparin-induced thrombocytopenia by real world database: a new role for primary hypercoagulable states. J Hematol (Brossard) 2021; 10 (04) 171-177
  • 27 Bousamra II M, Mewissen MW, Batter J, Presberg KW, Schlueter DP, Haasler GB. Pulmonary artery thrombolysis and stenting after a bilateral sequential lung transplantation. J Heart Lung Transplant 1997; 16 (06) 678-680
  • 28 Garcia MJ. Endovascular management of acute pulmonary embolism using the ultrasound-enhanced EkoSonic System. Semin Intervent Radiol 2015; 32 (04) 384-387
  • 29 Mathews SJ. Mechanical thrombectomy of pulmonary emboli with use of the indigo system and lightning 12 intelligent aspiration. Tex Heart Inst J 2021; 48 (05) e217571
  • 30 Heilman J. (2016). PELeftMark [Photograph]. Wikimedia Commons. Accessed April 29, 2024 at: https://commons.wikimedia.org/wiki/File:PELeftMark.png