TITLE

Airway complications after lung transplantation: risk factors, prevention and outcome

AUTHOR(S)
Weder, Walter; Inci, Ilhan; Korom, Stephan; Kestenholz, Peter B.; Hillinger, Sven; Eich, Christine; Irani, Sarosh; Lardinois, Didier
PUB. DATE
February 2009
SOURCE
European Journal of Cardio-Thoracic Surgery;Feb2009, Vol. 35 Issue 2, p293
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Abstract: Purpose: Anastomotic complications following lung transplantation (LuTx) have been described in up to 15% of patients. Challenging to treat, they are associated with high morbidity and a mortality rate of 2–5%. The aim of this study was to analyze the incidence of complications in a consecutive series of bronchial anastomosis after LuTx at our center and to delineate the potential risk factors. Methods: Between 1992 and 2007, 441 bronchial anastomoses were performed in 235 patients. Indications for transplantation were cystic fibrosis (35.7%) emphysema (28.1%) pulmonary fibrosis (12.8%) and pulmonary hypertension (7.7%). There were 206 sequential bilateral and 28 single transplants including lobar engraftments in 20 cases. The donor bronchus was shortened to the plane of the lobar carina including the medial wall of the intermediate bronchus. Peribronchial tissue was left untouched. Anastomosis was carried out using a continuous absorbable running suture (PDS 4/0) at the membranous and interrupted sutures at the cartilaginous part. Six elective surveillance bronchoscopies were done monthly during the first half-year post-LuTx, with detailed assessment of the pre- and post-anastomotic airways. Results: One-year survival since 2000 was 90.5%. In all 441 anastomoses performed, no significant dehiscence was observed. In one patient, a small fistula was detected and closed surgically on postoperative day five. Fungal membranes were found in 50% of the anastomoses at 1 month and in 14% at 6 months. Discrete narrowing of the anastomotic lumen without need for intervention was found in 4.9% of patients at 1 month and in 2.4% at 6 months. Age, cytomegalovirus status, induction therapy, immunosuppressive regimen, ischemic time, and ventilation time had no influence on bronchial healing. Conclusions: Clinically relevant bronchial anastomotic complications after LuTx can be avoided by use of a simple standardized surgical technique. Aggressive antibiotic and antifungal therapy might play an important supportive role.
ACCESSION #
36192338

 

Related Articles

  • Does anaesthetic management affect early outcomes after lung transplant? An exploratory analysis. D. R. McIlroy; D. V. Pilcher; G. I. Snell // BJA: The British Journal of Anaesthesia;Apr2009, Vol. 102 Issue 4, p506 

    Background Primary graft dysfunction (PGD) is a predominant cause of early morbidity and mortality after lung transplantation. Although substantial work has been done to understand risk factors for PGD in terms of donor, recipient, and surgical factors, little is understood regarding the...

  • Incidence, management and clinical outcomes of patients with airway complications following lung transplantation. Moreno, Paula; Alvarez, Antonio; Algar, Francisco Javier; Cano, José Ramón; Espinosa, Dionisio; Cerezo, Francisco; Baamonde, Carlos; Salvatierra, Angel // European Journal of Cardio-Thoracic Surgery;Dec2008, Vol. 34 Issue 6, p1198 

    Abstract: Objective: Airway complications (AC) remain a significant contributing factor of morbidity after lung transplantation (LT). The aim of this study was to identify risk factors for AC, and to review the outcomes after endoscopic and surgical treatment. Methods: From 1993 to 2006, 255...

  • Fulminant hyperacute rejection after unilateral lung transplantation. Campo-Cañaveral de la Cruz, Jose Luis; Naranjo, Jose Manuel; Salas, Clara; Varela de Ugarte, Andres // European Journal of Cardio-Thoracic Surgery;Aug2012, Vol. 42 Issue 2, p373 

    Hyperacute rejection (HAR) is a well-known complication in renal and cardiac transplantation, but rare in lung recipients. We present a case of HAR of the lung graft with a fatal outcome of a male patient with preformed class II anti-HLA antibodies.

  • Lung Transplantation Biopsy Specimens With Bronchiolitis Obliterans or Bronchiolitis Obliterans Organizing Pneumonia Due to Aspiration.  // Archives of Pathology & Laboratory Medicine;Feb2005, Vol. 129 Issue 2, p223 

    Context.-Bronchiolitis obliterans (BO) is generally thought to be a marker of chronic airway rejection in patients who have undergone lung transplantation. Bronchoscopic biopsy specimens, by virtue of their small size, may sample only BO and not a lesion of bronchiolitis obliterans organizing...

  • Pneumonia in Lung Transplant Recipients. Otero, Isabel; Sanjuán, Maria P.; Fernández-Marrube, Maria del M.; Verea, Hector // Current Respiratory Medicine Reviews;2010, Vol. 6 Issue 3, p171 

    Infections after lung transplantation are a major cause of morbidity and mortality. Bacteria, fungus and virus are the most common pathogens at the respiratory tract. This short review analyzes pneumonias in LTR with special emphasis on preventive strategies.

  • Combination of everolimus with calcineurin inhibitor medication resulted in post-transplant haemolytic uraemic syndrome in lung transplant recipients—a case series. Lovric, Svjetlana; Kielstein, Jan T.; Kayser, Daniel; Bröcker, Verena; Becker, Jan U.; Hiss, Marcus; Schiffer, Mario; Sommerwerck, Urte; Haller, Hermann; Strüber, Martin; Welte, Tobias; Gottlieb, Jens // Nephrology Dialysis Transplantation;Sep2011, Vol. 26 Issue 9, p3032 

    Background. Post-transplant haemolytic uraemic syndrome (HUS) is a rare but serious disease with a high mortality rate, when left untreated. Immunosuppressive drugs like calcineurin inhibitors as well as mammalian target of rapamycin inhibitors have been reported as causative agents for...

  • Urological complications after renal transplantation. Cranston, D. // Journal of the Royal Society of Medicine (Supplement);Jul1996, Vol. 89 Issue 29, p22 

    The article examines several urological complications following renal transplantation. The surgical procedure is preferred by patients with end-stage renal disease. Incidence of urological complications have reached 30% because of immunosuppressive treatments including high steroid dosage....

  • The challenge of acute rejection in intestinal transplantation. Yoshitoshi, E.; Yoshizawa, A.; Ogawa, E.; Kaneshiro, M.; Takada, N.; Okamoto, S.; Fujimoto, Y.; Sakamoto, S.; Masuda, S.; Matsuura, M.; Nakase, Y.; Chiba, T.; Tsuruyama, T.; Haga, H.; Uemoto, S. // Pediatric Surgery International;Aug2012, Vol. 28 Issue 8, p855 

    Early diagnosis and treatment of acute cellular rejection (ACR) after intestinal transplantation (ITx) is challenging. We report the outcome of three patients: two presented mild ACR improved with steroids. One presented steroid-resistant severe rejection, improved after rabbit anti-thymocyte...

  • Outcome of 67 patients with solid tumors relapsed after high-dose chemotherapy and peripheral blood stem cell transplantation. Bojko, P; Akca, A; Seeber, S // Bone Marrow Transplantation;Jun2003, Vol. 31 Issue 11, p995 

    Summary:We retrospectively analyzed the outcome of 67 patients with breast (n=24), ovarian (n=11) or testicular cancer (n=32) treated for relapse after high-dose chemotherapy (HDC) and peripheral blood stem cell (PBSC) transplantation. Treatment, survival and toxicity were analyzed. Patients...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics