Objective : Lung transplantation (LTx) is a valuable therapeutic option for selected patients with end-stage pulmonary disease. This treatment has enjoyed increasing success with better early and late survival. Nevertheless, airway anastomotic complications are still a potential cause of morbidity and mortality. The purpose of this study was to review the results of bronchial healing in our LTx population over the past 13 years.
Methods : Between July 1991 and December 2004, 232 consecutive single (n=102) and bilateral (n=130) lung transplantations were performed. There were 142 male patients and 90 female patients with a mean age of 48 years (range 15 – 66 years). The indications for LTx were emphysema (n=113), pulmonary fibrosis (n=45), cystic fibrosis (n=35), pulmonary hypertension (n=10), sarcoidosis (n=7) and other indications (n=22). Bronchial anastomoses (n=362) were performed using a telescoping (T, n=23), an interrupted end-to-end (IE, n=309) or a continuous end-to-end (CE, n=30) technique. Complications were categorized as stenosis, dehiscence, malacia or fistula.
Results: Fifty-seven complications occurred in 362 airway anastomoses (15.7%): dehiscence (n=29), stenosis (n=15), malacia (n=5) and fistula (n=8). Six patients (2.6%) died directly from an airway complication: massive bleeding (n=4) and brain death (n=2). Complications occurred more often in bilateral lung transplantation compared to single lung transplantation (45/260 anastomoses [17.3%] versus 12/102 anastomoses [11.8%]). The use of IE or CE were associated with less complications (45/309 [14.6%] and 5/30 [16.7%]); respectively compared to T (7/23 [30.4%]) (p<0.05). Surgical or medical intervention was necessary for 36 anastomotic complications (9.9%). The others were treated conservatively (5.8%). Patients with airway complications had a longer ICU stay (26.2 ± 4.3 days versus 16.2 ± 1.1 days [p<0.05]), longer hospital stay (56.5 ± 7.4 days versus 38.9 ± 2.1 days [p<0.05]) and lower survival (50.9% versus 67.1% at 3 years). There was no significant difference in the length of mechanical ventilation (12.8 ± 3 days versus 8.1 ± 0.9 days).
Conclusion : Airway anastomotic complications after lung transplantation remain a challenging problem. The high incidence of complications in our early experience decreased after the telescoping technique was abandoned. Our results are comparable with other reported series.