title: Evaluation of factors damaging the bronchial wall in lung transplantation.
abstract: BACKGROUND
  Lung transplantation has become important in treating end-stage lung disease; however, bronchial complications are common. Lack of bronchial arterial circulation, ischemic time, and acute rejection episodes may damage the bronchial wall. In this study, we analyzed factors that may hamper bronchial airway healing, requiring intervention after lung transplantation.
  
  
  METHODS
  We collected data from a consecutive series of 81 transplantations performed between 1993 and 2002 and evaluated recipients for bronchial complications. In 30 single and 51 sequential bilateral lung transplantations, a total of 132 anastomoses were performed. Four patients (3 bilateral and 1 single lung transplant recipients who died within the first 14 post-operative days were excluded from the analysis. Finally, 125 lung grafts remained for statistical analysis of factors influencing bronchial complications.
  
  
  RESULTS
  Peri-operative mortality was 8.9%. Eleven patients (14.7%) experienced severe bronchial complications in 16 of 125 evaluated bronchial anastomoses (12.8%) and required surgical treatment or bronchoscopic interventional therapy. In a multivariate logistic regression model, severe reperfusion edema (adjusted odds ratio, 8.3; p = 0.002) and rejection episode within the 1st post-operative month (adjusted odds ratio, 4.1; p = 0.036) were associated with bronchial complications. Using the univariate model, we found that factors such as interleukin-2-antibody induction therapy, immunosuppression, or bronchial anastomotic technique had significant influence on bronchial healing, whereas we could not confirm this when using multivariate anasysis.
  
  
  CONCLUSIONS
  Preventing reperfusion edema with optimized lung preservation and with early and aggressive medical treatment or mechanical hemodynamical support (e.g., veno-arterial extra corporal membrane oxygenation are necessary to avoid prolonged ventilation dependence, which may result in bronchial complications. Furthermore, avoiding early rejection episodes promotes uncomplicated bronchial healing.
authors.affiliation: Department of Cardiac Surgery, University of Innsbruck, Innsbruck, Austria.
authors.forename: Elfriede
authors.initials: E
authors.lastname: Ruttmann
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.forename: Martina
authors.initials: M
authors.lastname: Marchese
authors.forename: Karin
authors.initials: K
authors.lastname: Dunst
authors.forename: Christian
authors.initials: C
authors.lastname: Geltner
authors.forename: Raimund
authors.initials: R
authors.lastname: Margreiter
authors.forename: Guenther
authors.initials: G
authors.lastname: Laufer
authors.forename: Ludwig C
authors.initials: LC
authors.lastname: Mueller
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D001980:Bronchi / Q000293:injuries*; D001999:Bronchoscopy; D004487:Edema / Q000453:epidemiology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D014945:Wound Healing