Bronchial anastomotic complications responsible for early failure of clinical lung transplantation can affect outcome today. Reported incidence of this complication greatly varies among institutions. Donor selection, preservation technique and recipient management are likely important factors as the surgical technique.
We performed a retrospective review of patients undergoing lung transplantation between August 1998 and March of 2003 for incidence of significant bronchial anastomotic complication. During this period lung transplantation was performed for end-stage obstructive airway disease in 67, for suppurative lung disease in 27, for pulmonary fibrosis in 32, for sarcoid in 11, and for pulmonary hypertension in 8. Transplantation included 70 single lung transplantations (31 left and 39 right), 72 bilateral transplantations and three heart lung transplantation accounting for 220 bronchial anastomoses at risk for developing complications. Of these 6 were repeat transplantations. The organ preservation was with cold Euro-Collins flush for the first 81 patients and Perfedex solution for the remaining 64 patients.
Twenty four patients (16.55%) developed 27 significant anastomotic bronchial complications (12.27%) requiring intervention. In thirteen patients the pathology was stenosis (in 2 leading to complete obstruction), in 4 it was only malacia and in 7 it was a mixed type. In two patients only a dilatation was required, in 21 a stent was placed, one required surgical revision of anastomosis and in the other endoscopic debridement alone was performed. There were 20 left sided and 7 right sided complications. Two deaths among this group could be accounted for the bronchial complication. The side of transplant was the only significant risk factor for developing an anastomotic complication.
The incidence of bronchial complication following lung transplantation remains significant. Surgical technique and ischemia may be significant factor in the development. Majority of the complications are treated effectively with endoscopic techniques.
Future advances in the donor preservation and recipient management including lung implatation, treatment of sub-clinical rejection and infection are necessary to further reduce this morbidity following lung transplantation.
W.T. Vigneswaran, None.