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