Contemporary Updates in Lung Transplantation: a Perioperative and Critical Care Anesthesiology Perspective

Abstract Purpose of Review This review reports advances from the past five years in the perioperative and critical care management of lung transplantation, emphasizing donor pool expansion, selection of intraoperative mechanical support, ventilation of the allograft, and mitigation of primary graft dysfunction. Recent Findings Ex vivo lung perfusion and donation after circulatory death, with normothermic regional perfusion, have enlarged the usable donor pool. Observational data and 2026 consensus statements favor venoarterial extracorporeal membrane oxygenation over cardiopulmonary bypass when intraoperative support is required, although those data cannot evaluate a planned routine support strategy. Ventilation of the allograft is becoming graft-specific rather than borrowed from acute respiratory distress syndrome practice, and enhanced recovery pathways with regional analgesia are being applied across the perioperative continuum. Summary Perioperative anesthesia management materially influences lung transplant outcomes. Priorities for future work include standardized intraoperative extracorporeal membrane oxygenation protocols, individualized ventilation, opioid-sparing analgesia, and prevention of chronic lung allograft dysfunction.