Bronchial anastomotic complications following lung transplantation: still a major cause of morbidity?

Abstract

B Br ro on nc ch hi ia al l aan na as st to om mo ot ti ic c c co om mp pl li ic ca at ti io on ns s f fo ol ll lo ow wi in ng g l lu un ng g t tr ra an ns sp pl la an nt ta at ti io on n: : s st ti il ll l a a m ma aj jo or r c ca au us se e o of f m mo or rb bi id di it ty y? ? We have, therefore, reviewed the results of 67 consecutive bronchial anastomoses at risk in 43 patients surviving more than 7 days following lung transplantation. The bronchial anastomoses were performed using a standardized technique, without direct or indirect revascularization. Regular triple immunosuppressive therapy was given, including prednisone (0.5 mg·kg -1 daily) starting on the day of surgery. Bronchial healing was graded using the Couraud classification. The median follow-up time was 14 months (range 1-45 months).No major airway complications occurred. On 236 serial bronchoscopic examinations, no anastomotic stenoses were observed. One anastomosis showed limited focal necrosis (2 mm) (Couraud 3a), and two anastomoses had partial primary mucosal healing without necrosis (Couraud 2a). In all other anastomoses, primary mucosal healing (Couraud 1) was observed.Carefully performed bronchial anastomosis according to the technique described enables reliable bronchial healing and yields a low complication rate. Additional measures, such as direct revascularization, forced telescoping, omentum wrap and interruption of steroid therapy, are not necessary.

Bronchial healing after living-donor lobar lung transplantation

“…It should also be noted that the incidence of AC in our CLT group (21.4%) was higher than that recently reported in Western countries (7%-15.7%), where CLT is the major type of transplantation. 4,20,23 However, the reason for this discrepancy is unknown. Because the general condition of CLT recipients is better than that of LDLLT recipients, 24,25 according to the policy of LDLLT at our institution donor factors, such as the period of preoperative ventilation, are regarded with special concern, relative to recipient factors.…”

Lung Transplantation for Pulmonary Arterial Hypertension

“…Focal dehiscence, incidentally detected on bronchoscopy or heralded by a spontaneous pneumothorax, is still encountered in 1-6 percent of patients. [58][59][60] Tube thoracostomy may be required for evacuation of pneumothoraces, but focal dehiscence usually heals without surgical intervention.…”

Successful Treatment of Bronchial Dehiscence With Endobronchial Stent in Lung Transplantation

“…The reported incidence of bronchial complications ranges from 12% to 17% [2], in spite of the different solutions adopted to prevent them, such as direct revascularization of the bronchus [3], telescoping anastomosis, shortening of the bronchial stump, anastomosis wrapping with omentum, intercostal muscle, pericardiac fat, peribronchial tissue, etc. [4][5][6][7].…”