Endoscopic diagnostics of bronchial complications after lung transplantation

Abstract

Currently, lung transplantation (LT) is a generally accepted method of treating a wide range of terminal lung diseases that are not amenable to medical or surgical methods of correction. The aim of the study was to determine the frequency and nature of bronchial complications in patients after bilateral LT. Methods. This article presents an analysis of the frequency and the nature of bronchial complications in 49 patients after bilateral LT. All patients underwent bronchoscopy intraoperatively, at the stage of bronchial anastomoses formation, and after the operation. A total of 775 bronchoscopies were performed in 49 patients after lung transplantation. All patients were divided into 2 groups according to the results of bronchoscopy. The first group included 41 patients (83.7%) who had 66 clinically insignificant bronchial complications in the form of ischemia of the bronchial mucosa of I – IV degrees. The second group included 8 patients (16.3%) with 10 clinically significant bronchial complications represented by dehiscence of bronchial anastomoses, anastomotic and non-anastomotic stenoses of the bronchi. Results. Perioperative factors of donors and recipients that could be associated with the development of bronchial complications were analyzed. However, statistically significant differences were not observed for all indicators due to the small number of observations. The analysis showed a direct relationship between the incidence of bronchial complications and the duration of mechanical ventilation in the postoperative period. Conclusion. Thus, according to our experience, the incidence of clinically significant bronchial complications after LT is 16.3%. Improving surgical tactics, timely diagnosis of signs of rejection and infectious complications, early extubation and intraoperative use of extracorporeal membrane oxygenation can play an important role in reducing the incidence of bronchial complications in the post-transplant period.