Management of airway complications following lung transplantation

Abstract

Airway complications (ACs) following lung transplantation are a significant source of morbidity and mortality. The incidence of ACs has decreased over the years with advances in surgical technique.Airway ischemia is thought to be a main risk factor for formation of ACs, although other risk factors are being studied. There is not yet a universally accepted system for grading ACs. These complications include bronchial stenosis, airway necrosis or dehiscence, fistula formation, anastomotic infection, granulation tissue formation, and tracheobronchomalacia. The management of ACs requires a multimodal approach.Bronchoscopic management options include balloon bronchoplasty, cryotherapy, and stent placement.Medical management including antibiotics, mucus clearance techniques and positive pressure ventilation also play a role; surgical management is considered in select cases. This article reviews the risk factors associated with the development of ACs, the clinical presentation and classification of ACs, and current management paradigms.