Perioperative management of transforaminal lumbar interbody fusion in a post-double lung transplant recipient: A case report

Background: As long-term survival following lung transplantation improves, anesthesiologists increasingly encounter such patients for elective non-transplant surgeries. These patients present unique perioperative challenges due to altered pulmonary physiology, chronic immunosuppression, and multiple comorbidities.Case Presentation: We report the case of a 56-year-old female with a history of double lung transplantation in 2022, who presented with severe lumbar spinal canal stenosis and underwent elective L4-L5 transforaminal lumbar interbody fusion (TLIF) with L3-L4 decompression. Her comorbidities included well-controlled hypertension, type 2 diabetes mellitus, hypothyroidism post-total thyroidectomy, and she was on maintenance immunosuppressive therapy. Preoperative investigations revealed a restrictive pulmonary pattern, cardiomegaly with a dilated main pulmonary artery, mosaic attenuation in both lungs, and an ejection fraction of 70% with mild left atrial enlargement. She was evaluated and deemed fit for surgery by a multidisciplinary team including a chest physician, cardiologist, and nephrologist. The procedure was successfully performed under general anesthesia with lung-protective ventilation and strict aseptic precautions. Her postoperative course was uneventful, and she was discharged on postoperative day six.Conclusion: This case underscores the importance of individualized perioperative management, vigilant respiratory and infection control strategies, and multidisciplinary coordination in ensuring favorable outcomes for lung transplant recipients undergoing elective spine surgery.