Clinical lung and heart/lung transplantation
Evaluation of factors damaging the bronchial wall in lung transplantation

Presented at the 11th Congress of the European Society of Organ Transplantation, Venice, Italy, September 2003.
https://doi.org/10.1016/j.healun.2004.01.008Get rights and content

Abstract

Background

Lung transplantation has become important in treating end-stage lung disease; however, bronchial complications are common. Lack of bronchial arterial circulation, ischemic time, and acute rejection episodes may damage the bronchial wall. In this study, we analyzed factors that may hamper bronchial airway healing, requiring intervention after lung transplantation.

Methods

We collected data from a consecutive series of 81 transplantations performed between 1993 and 2002 and evaluated recipients for bronchial complications. In 30 single and 51 sequential bilateral lung transplantations, a total of 132 anastomoses were performed. Four patients (3 bilateral and 1 single lung transplant recipients who died within the first 14 post-operative days were excluded from the analysis. Finally, 125 lung grafts remained for statistical analysis of factors influencing bronchial complications.

Results

Peri-operative mortality was 8.9%. Eleven patients (14.7%) experienced severe bronchial complications in 16 of 125 evaluated bronchial anastomoses (12.8%) and required surgical treatment or bronchoscopic interventional therapy. In a multivariate logistic regression model, severe reperfusion edema (adjusted odds ratio, 8.3; p = 0.002) and rejection episode within the 1st post-operative month (adjusted odds ratio, 4.1; p = 0.036) were associated with bronchial complications. Using the univariate model, we found that factors such as interleukin-2-antibody induction therapy, immunosuppression, or bronchial anastomotic technique had significant influence on bronchial healing, whereas we could not confirm this when using multivariate anasysis.

Conclusions

Preventing reperfusion edema with optimized lung preservation and with early and aggressive medical treatment or mechanical hemodynamical support (e.g., veno-arterial extra corporal membrane oxygenation are necessary to avoid prolonged ventilation dependence, which may result in bronchial complications. Furthermore, avoiding early rejection episodes promotes uncomplicated bronchial healing.

Section snippets

Patients

From November 1993 to September 2002, 81 consecutive lung transplantation (30 single and 51 bilateral), including 6 retransplantations, were performed in 75 patients. Five patients required invasive ventilation before transplantation. Previous lung surgery was documented in 31 cases (38.3%), i.e., primarily lung-volume reduction surgery (14 patients, 17.3%). Chronic obstructive pulmonary disease was the most common indication for lung transplantation (52.0%), followed by α1

Bronchial complications

We reviewed 125 bronchial anastomoses at risk in 71 patients (77 transplantations). Bronchial complications, mostly occurring within the 1st few months, developed in 11 patients (12 transplantations), resulting in surgical treatment or interventional therapy in 16 anastomoses. For an overview of bronchial complications, see Figure 1. Anastomoses showing bronchial stenosis caused by granulation tissue (10 anastomoses) could be treated by bronchoscopic laser debridement. Interventional therapy

Discussion

To our knowledge, this is the 1st study that identifies severe reperfusion edema and early rejection episodes as independent predictors of bronchial complications. Severe reperfusion edema increased the incidence of bronchial complications >8-fold. Additionally, an early rejection episode that required corticosteroid administration increased the risk for surgical treatment or interventional therapy for bronchial complications.

Several studies have attempted to identify predisposing parameters

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