Abstract
PurposeBronchial stenoses are challenging complications after lung transplantation and are associated with high rates of morbidity and mortality. We report a series of patients who underwent bronchoplasty or sleeve resection for bronchial stenoses that did not resolve with endoscopic treatment after lung transplantation.MethodsBetween 1995 and 2020, 497 patients underwent lung transplantation at our Institution. 35 patients (7.0%) experienced bronchial stenoses with a median time from transplantation of 3 months. Endoscopic management was effective in 28 cases (5.6%) while 1 patient required re-transplantation. Six patients (1.2%) underwent bronchoplasty or sleeve resection.ResultsThe procedures of the six patients who underwent bronchoplasty or sleeve resection were as follows: lower sleeve bilobectomy (n = 3), wedge bronchoplasty of the bronchus intermedius (n = 1), isolated sleeve resection of the bronchus intermedius (n = 1), and isolated sleeve resection of the bronchus intermedius (n = 1), associated with a middle lobectomy. All patients were discharged after a median time of 11 days. At a median of 12 months from surgery, two patients remain alive with a preserved pulmonary function. Four patients died after a median time of 56 months from bronchoplasty of causes that were not related to surgery.ConclusionsBronchial reconstructions are challenging procedures that can be performed in highly specialized centers. Despite this, they can be considered a good strategy to obtain a definitive resolution of stenosis after lung transplantation.
Highlights
Despite the improvement in surgical technique, bronchial complications continue to represent a significant and challenging problem after lung transplantation, with incidence rates ranging from 1.6 to 33% [1]
After excluding one patient who was unresponsive to endoscopic treatment and who required retransplantation due to severe bilateral bronchial stenosis, a conservative approach failed in six patients (1.2%), and surgical treatment was performed
The most frequent post-transplant airway complications, can be located at the bronchial anastomosis or within 2 cm of the anastomotic site otherwise they can involve the airways distal to the anastomotic site
Summary
Despite the improvement in surgical technique, bronchial complications continue to represent a significant and challenging problem after lung transplantation, with incidence rates ranging from 1.6 to 33% [1]. Hypoperfusion, right-sided anastomoses, organ preservation, primary graft dysfunction, immunosuppression, infections, acute cellular rejection, ischemic time and anastomotic surgical technique represent the main risk factors for airway complications [2]. The clinical presentations of bronchial complications in lung recipients are varied, including focal infection, necrosis, dehiscence, fistulae and granulation tissue formation, stenosis and malacia [3]. Bronchial stenoses are the most common airways complications after lung transplantation with a reported of 1.6–32% [3] and some known risk factors, including dehiscence, necrosis, bacterial (especially Actinomyces and Pseudomonas Aeruginosa) and/or fungus (Aspergillus) infection.
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