Patient 2
A 35year-old male with cystic fibrosis (CF) had a recurrent history of hemoptysis as well as infectious exacerbations in the past. Due to these exacerbations, the patient developed a retracted right lung with concurrent right sided mediastinal shift (Figure 2A ). He underwent a sequential double lung transplantation on cardiopulmonary bypass support. Due to intraoperative coagulopathy and size mismatch, we elected to perform a delayed closure on POD 2 in the OR after a chest washout with antibiotics. No donor lung volume reduction was necessary to close his chest. His hospital course was complicated with respiratory insufficiency requiring tracheostomy and acute kidney injury requiring renal replacement therapy. Prior to being discharged on POD 52, his tracheostomy was decannulated and his kidney function returned to normal levels. Both lungs were fully expanded, and the mediastinum was centered. (Figure 2B )