Thoracic Complications After Kidney Transplantation
Özet
Thoracic complications after kidney transplantation constitute a heterogeneous clinical spectrum ranging from early postoperative respiratory impairment to late infectious, thromboembolic, pleural, malignant, and ventilation-related disorders. Their evaluation requires more than routine postoperative respiratory assessment because immunosuppression, graft function, renal-adjusted therapies, altered inflammatory responses, and competing diagnoses frequently obscure the clinical picture. This chapter reviews thoracic complications from a thoracic surgery-oriented perspective, emphasizing practical diagnostic pathways, indications for invasive evaluation, and situations in which surgical intervention becomes necessary. Particular attention is given to postoperative atelectasis and pneumonia, pleural effusion and pleural infection, pulmonary embolism, thoracic malignancies, pulmonary nodules, post-transplant lymphoproliferative disorder, diaphragmatic dysfunction, and complex pleural or pulmonary conditions requiring video-assisted thoracoscopic surgery. The chapter highlights the importance of differentiating reversible postoperative changes from complications requiring microbiologic diagnosis, pleural drainage, bronchoscopy, tissue biopsy, oncologic staging, or operative management. Because evidence specific to kidney transplant recipients remains limited for several thoracic conditions, general thoracic, pulmonary, and thromboembolic principles should be applied with transplant-specific caution. Early recognition, structured assessment, individualized risk evaluation, and coordinated multidisciplinary care are central to improving outcomes in this vulnerable patient population.
Referanslar
Miskovic A, Lumb AB. Postoperative pulmonary complications. British Journal of Anaesthesia. 2017;118(3):317–334. DOI: 10.1093/bja/aex002. PMID: 28186222.
Wu X, Zhang H, Cai M, Zhang Y, Xu A. Predicting the risk of pulmonary infection after kid- ney transplantation using machine learning methods: a retrospective cohort study. Interna- tional Urology and Nephrology. 2025;57:947–955. DOI: 10.1007/s11255-024-04264-6. PMID: 39488661.
Dulek DE, Mueller NJ. Pneumonia in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clinical Transplanta- tion. 2019;33(9):e13545. DOI: 10.1111/ctr.13545. PMID: 30900275.
Bhargava V, Meena P, Bhalla AK, et al. Prevalence, risk, and outcomes of venous thrombo- embolic events in kidney transplant recipients: a nested case-control study. Renal Failure. 2023;45(1):2161395. DOI: 10.1080/0886022X.2022.2161395. PMID: 36688793.
Massicotte-Azarniouch D, Noel JA, Knoll GA. Epidemiology of cancer in kidney transplant recip- ients. Seminars in Nephrology. 2024;44(1):151494. DOI: 10.1016/j.semnephrol.2024.151494. PMID: 38538455.
Nimmo A, Elyan B, Lakey J, et al. Increased cancer risk in kidney transplant patients in Scotland: a national registry linkage study. British Journal of Cancer. 2025;133:555–563. DOI: 10.1038/ s41416-025-03086-2. PMID: 40517146.
Poddighe D, Van Hollebeke M, Rodrigues A, et al. Respiratory muscle dysfunction in acute and chronic respiratory failure: how to diagnose and how to treat? European Respiratory Review. 2024;33(174):240150. DOI: 10.1183/16000617.0150-2024. PMID: 39631928.
BTS Pleural Guideline Development Group. British Thoracic Society Guideline for pleural dis- ease. Thorax. 2023;78(Suppl 3):s1–s42. DOI: 10.1136/thorax-2022-219784. PMID: 37433578.
Bedawi EO, Ricciardi S, Hassan M, etal. ERS/ESTSstatementonthemanagementofpleuralinfection in adults. European Respiratory Journal. 2023;61(2):2201062. DOI: 10.1183/13993003.01062- 2022. PMID: 36229045.
Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and man- agement of acute pulmonary embolism developed in collaboration with the ERS. European Heart Journal. 2020;41(4):543–603. DOI: 10.1093/eurheartj/ehz405. PMID: 31504429.
Stevens SM, Woller SC, Baumann Kreuziger L, et al. Antithrombotic therapy for VTE disease: second update of the CHEST Guideline and Expert Panel Report. Chest. 2021;160(6):e545– e608. DOI: 10.1016/j.chest.2021.07.055. PMID: 34352278.
Mansell H, Shoker A, Alcorn J, et al. Pharmacokinetics of apixaban and tacrolimus or cy- closporine in kidney and lung transplant recipients. Clinical and Translational Science. 2022;15(7):1687–1697. DOI: 10.1111/cts.13284. PMID: 35439353.
Watanabe H, Kadomatsu Y, Hakiri S, et al. Lung cancer after kidney transplantation: a 50- year experience at a single institution. Surgery Today. 2024;54(10):1124–1130. DOI: 10.1007/ s00595-024-02819-9. PMID: 38546862.
Krist AH, Davidson KW, Mangione CM, et al. Screening for lung cancer: US Preventive Ser- vices Task Force recommendation statement. JAMA. 2021;325(10):962–970. DOI: 10.1001/ jama.2021.1117. PMID: 33687470.
Dharnidharka VR, Ruzinova MB, Marks LJ. Post-transplant lymphoproliferative disorders. Seminars in Nephrology. 2024;44(1):151503. DOI: 10.1016/j.semnephrol.2024.151503. PMID: 38519279.
