Bronchial complications following lung transplantation.
BACKGROUND
Bronchial complications owing to the airway anastomosis in lung transplantation are important causes of morbidity and mortality. They occur in up to 27% of cases as defined by stenosis, necrosis, and dehiscence. Treatment depends on the type of complication.


OBJECTIVE
To report our experience to treat this complication.


METHODS
Between 2000 and 2007, we performed 71 lung transplants of which 36 were bilateral. The total number of anastomoses was 107:52 to the right and 55 to the left. The telescoping technique was initially used (14 initial unilateral transplants), and after October, 2003 it was changed to an end-to-end anastomosis (57 transplants and 93 anastomoses).


RESULTS
Eight patients developed bronchial complications including two that were bilateral. There were 4 stenosis, 3 dehiscences, and 3 necrosis complications (9.4%). The complication rate for telescoping anastomosis was 21.4%, and for the end-to-end technique, 7.5%. The treatment of the stenosis used metallic or plastic self-expandable stents. Two bronchial dehiscences resulted in case of bronchopleural fistulae, empyema, and death; the other patient experienced spontaneous resolution. Concerning bronchial necrosis, 1 patient developed fistulization to the pulmonary artery and massive hemoptysis, and the other with bilateral necrosis, a spontaneous resolution.


CONCLUSIONS
Our bronchial anastomosis complication rate was comparable with that in other reports. The rate for the telescoping technique was greater compared with the end-to-end technique. The treatment of bronchial stenosis with a self-expandable prosthesis showed good results.
Thoracic Surgery Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. marcos.samano@incor.usp.br
M N
MN
Samano
H
H
Minamoto
J J M
JJ
Junqueira
K G R
KG
Yamaçake
H A P
HA
Gomes
A W
AW
Mariani
P M
PM
Pêgo-Fernandes
F B
FB
Jatene
D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001982:Bronchial Diseases / Q000453:epidemiology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D006982:Hypertonic Solutions; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D019188:Organ Preservation Solutions; D011126:Polypropylenes; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery; D011658:Pulmonary Fibrosis / Q000601:surgery; D012189:Retrospective Studies; D013537:Sutures; D016896:Treatment Outcome
C037096:Euro-Collins' solution; D006982:Hypertonic Solutions; D019188:Organ Preservation Solutions; D011126:Polypropylenes