Anastomotic complications after lung transplantation

Abstract

: Anastomotic complications following lung transplantation include those affecting one of the three anastomoses performed in the usual technique for lung transplantation: the bronchial, the pulmonary artery, and the pulmonary venous anastomoses. Airway complications have declined over time, but still are associated with significant morbidity and mortality. The main pathogenic factor associated to the development of airway complications is the post-transplant bronchial ischemia. The most frequent anastomotic airway complication is bronchial stenosis. Other complications include bronchial dehiscence, granulation tissue formation, bronchomalacia, and bronchial fistulae. The main diagnostic tools for diagnosis of such complications are imaging techniques such as chest computed tomography (CT) scan and bronchoscopic examination, which allows an appropriate assessment of the bronchial mucosa and extent of the airway complication. A combination of several bronchoscopic procedures is usually required to best manage post-transplant airway complications. These include balloon dilatation, cryotherapy, laser resection, electrocautery, endobronchial brachytherapy, and bronchial stenting. On occasion, different surgical approaches are required, including graft resection or re-transplantation. The incidence of vascular anastomotic complications after lung transplantation is low, but they are associated to high morbidity and mortality rates. These complications comprise either the pulmonary artery anastomosis or the venous anastomosis, and stenoses are the most frequently observed. In the pulmonary artery, an excessive length of vascular ends may lead to kinking, vascular torsion, and stenosis. In the venous anastomosis, an improper surgical technique, or an anastomotic intussusception due to excessive lengh leads to the development of thrombosis at the anastomotic site. Early detection and rapid treatment of these complications is crucial for its successful management. Appropriate selection of the best therapeutic option depends on the time of onset of the vascular complication and the expertise of the transplant team. It usually requires a multidisciplinary approach comprising either endovascular procedures or surgical correction.