Airway complications in lung transplantation.
This article reviews the literature on airway healing after lung transplantation. From a historical point of view, this has been the Achilles' heel of lung transplantation through two decades, from the first attempt at single-lung transplantation in 1963 to the clinical successes in the early 1980s. The overall incidence of lethal airway complications is estimated to be 2% to 3%, whereas that of late stricture is 7% to 14%. Comparison of experiences has been difficult without a universal classification; a new classification for airway and anastomotic complications and healing is proposed. Ischemia appears to be the most important factor influencing airway healing. Low-pressure collateral bronchial blood flow from the pulmonary artery may be affected by low cardiac output, reperfusion edema, or rejection; mucosal injury may be further increased by prolonged positive-pressure ventilation. Good bronchial healing appears to be possible without a protective wrap and with early use of steroids. The management of bronchial complications is challenging and requires endoscopic skills including knowledge of endobronchial laser photocoagulation and stent insertion techniques.
Shennib
H
H
Joint Marseille-Montreal Lung Transplant Program, Marseille, France.
Massard
G
G
D000714:Anastomosis, Surgical; D001980:Bronchi / Q000473:pathology; D001982:Bronchial Diseases / Q000145:classification / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D016040:Lung Transplantation; D009336:Necrosis; D011183:Postoperative Complications / Q000209:etiology; D014945:Wound Healing