Early and late airway complications after lung transplantation: incidence and management.
BACKGROUND
Airway anastomosis complications continue to be a source of morbidity for lung transplant recipients.


METHODS
This study analyzes incidence, treatment, and follow-up of airway anastomotic complications occurring in 127 consecutive lung transplant airway anastomoses (77 single lung and 25 bilateral sequential lung). Complications were categorized as stenosis (11), granulation tissue (8), infection (7), bronchomalacia (5), or dehiscence (3). Follow-up after treatment ranged from 6 months to 4 years.


RESULTS
Nineteen airway anastomosis complications (15.0%) occurred in 18 patients. Telescoping the airway anastomosis reduced the complication rate to 12 of 97 (12.4%), compared with 7 of 30 (23.3%) for omental wrapping, (p = 0.15). Complications developed in 13 of 77 single-lung airway anastomoses (16.9%) versus 6 of 50 bilateral sequential lung recipients (12.0%). Treatment consisted of stenting (9 airway anastomoses), bronchodilation (8), laser debridement (4), rigid bronchoscopic debridement (2), operative revision (2), and growth factor application (2). There was no difference in actuarial survival between patients with or without airway anastomosis complications (p = 1.0).


CONCLUSIONS
Airway anastomosis complications can be successfully managed in the immediate or late postoperative period with good outcome up to 4 years after intervention.
Kshettry
V R
VR
Department of Radiology, University of Minnesota, Minneapolis, USA.
Kroshus
T J
TJ
Hertz
M I
MI
Hunter
D W
DW
Shumway
S J
SJ
Bolman
R M
RM
D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001982:Bronchial Diseases / Q000209:etiology* / Q000628:therapy; D002921:Cicatrix / Q000209:etiology / Q000601:surgery; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D003646:Debridement; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology*; D006097:Granulation Tissue / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000209:etiology; D008168:Lung / Q000098:blood supply; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology* / Q000628:therapy; D015996:Survival Rate