Decreased incidence of bronchial complications following lung transplantation

Abstract

Despite omental wrap and avoidance of prophylactic administration of corticosteroids in the early postoperative phase, ischemic bronchial complications still represent an important source of early morbidity and mortality following lung transplantation. In a retrospective analysis, the effect of pharmacological enhancement of pulmonary collateral flow on bronchial healing was investigated. Thirty-nine consecutive unilateral or bilateral transplant procedures (Tx) were analyzed. Immunosuppression consisted of rabbit antithymocyte globulin (RATG), cyclosporine A, and azathioprine. In group 1 (10 Tx, 12 anastomoses) routine immunosuppression was employed and the anastomoses wrapped with an omental or pericardial pedicle. In group 2 (29 Tx, 41 anastomoses) PGI2 (4 ng/kg per min x 48 h), heparin (200 U/kg per day), and prednisolone (0.5 mg/kg per day) were added to the therapeutic regimen. The 2 groups were comparable with respect to age and sex of the patients, primary diagnosis, type of transplant, intraoperative use of extracorporeal circulation, graft ischemia, duration of mechanical ventilation, and mortality. Bronchoscopic evidence of a significant bronchial ischemia (extending more than 1 cartilaginous ring beyond the anastomosis) was seen in 8 of 12 anastomoses in group 1 vs 14 of 53 anastomoses in group 2 (P = NS). In group 1, significant bronchial stenosis required implantation of an endobronchial silicone stent in 6 of 12 anastomoses, whereas in group 2, no significant bronchial stenosis occurred (P less than 0.01). No negative effects possibly related to the prophylactic administration of corticosteroids could be observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway complications after lung transplantation: risk factors, prevention and outcome☆

“…This technique, although widely used then, has been shown to be no longer essential [19]. We, like other transplant centers, also used omentopexy initially, but then abandoned this method.…”

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

“…Modification of the immunosuppressive regimen by avoiding the use of high-dose steroids in the early phase after transplantation has not reduced airway complications in lung graft recipients [20], and high-dose corticosteroids were not detrimental to bronchial healing in canine lung allografts [14,21].…”

“…An interesting approach to increase immediate retrograde perfusion to the donor bronchus was published by SCHÄFERS et al [20]. The authors demonstrated that the combined parenteral administration of heparin, prostaglandin I 2 (PGI 2 ) and prednisolone decreased the incidence of ischaemic bronchial complications of lung grafts.…”

Lung transplantation

“…For fear of an increased risk of bronchial complications, corticosteroids are not used in the first 2-3 postoperative weeks by most groups, and heavy preoperative corticoid therapy is considered a contraindication to transplantation [15]. Recently, however, experimental and clinical evidence has indicated a beneficial effect of the addition of corticosteroids to the routine immunosuppression [21]. Rejection episodes are usually treated by intravenous injection of methylprednisolone (10 mg/kg daily).…”

“…Lack of bronchial arterial blood supply and/or inadequate collateral circulation to the amputated bronchi appear to be the most import factors responsible for this complication. Direct revascularization of the bronchial arteries [4] or drug-mediated improvement of bronchial pulmonary collateral flow [21] have been attempted. Initial results with both approaches indicate a reduced incidence of airway complications.…”