Bleeding in the immediate postoperative period is detected by excessive drainage from the pleural chest tubes, need for blood transfusion to maintain adequate hemoglobin levels and stable hemodynamics, and chest radiograph changes consistent with hemothorax. Most commonly, bleeding is diffuse in nature and originates from the parietal pleura or the mediastinal soft tissue, and rarely from the vascular anastomoses. Postoperative hemorrhage is more frequent if it is necessary to use cardiopulmonary bypass and in the presence of dense intrapleural inflammatory adhesions. The latter is often the case in cystic fibrosis patients in whom donor pneumonectomy needs to be carried out with the greatest attention to hemostasis. Patients undergoing heart-lung transplantation are also at higher risk of bleeding from pulmonary-systemic collaterals.

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