Bronchial fistula after lobar size reduction for bilateral lung transplantation in Kartagener's syndrome: a surgical challenge

Abstract

Bilateral lung transplantation was performed in a 52-year old man with end-stage Kartagener's syndrome. A postimplantation right lower lobectomy was required for volume reduction and dextrocardia. A bronchial fistula developed with an intractable colonized residual pleural cavity. Closure was obtained successfully with multiple-stage procedures including decortication, muscle flap and an open-window thoracostomy without modification of the immunosuppressive protocol.

Efficacy of three-dimensional computed tomography volumetry for recipients in downsizing oversized grafts in brain-dead donor lung transplantation

“…In the current study, brain-dead donor lobar lung transplantation demonstrated excellent early and late post-transplant outcomes in comparison with standard lung transplantation using full-sized grafts. However, life-threatening bronchial complications such as bronchial fistula have been reported in lobar lung transplantation [ 11 , 12 ]. We performed lobar-to-lobar bronchial anastomoses to avoid leaving donor bronchial stumps closed, and thus there were no bronchopleural fistulae after brain-dead donor lobar lung transplantation (since initiating these types of transplantations, we have not had a patient experience bronchopleural fistulae).…”

Surgical management of bronchial stumps in lobar lung transplantation

“…[13][14][15][16] However, life-threating complications, including bronchial fistula, have been reported. 17,18 Our techniques of bronchial management are unique in that we allow leaving a recipient's bronchial stump and avoid leaving donor bronchial stumps by using lobar-to-lobar bronchial anastomosis.…”

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“…3 Brioude and associates mentioned that the surgical procedure of KS patients does not seem to require specific technical modifications when performed with lungs provided by a normal donor. 1 Similarly, Graeter and associates performed a double lung transplant for KS and emphasized that no technical modifications were necessary. 2 Despite the successful experiences of these authors, we do not agree with them; anatomic obstacles may have seen.…”

“…Kartagener syndrome (KS) is an uncommon, congenital, genetic disorder characterized by bronchiectasis, situs inversus totalis thoracalis et abdominalis, immotile cilia, chronic sinusitis, and infertility. 1,2 Lung transplant is a treatment option for terminal-stage bronchiectasis. We present a case of KS, to highlight the importance of related anatomic variations pitfall that may influence the decision for patient selection and may complicate the course of the operation.…”