Bronchial Anastomotic Complications After Lung Transplantation

This study assessed the clinical and endoscopic findings of bronchial anastomotic complications after lung transplantation. A total of 33 bronchial anastomotic complications occurred in 23 (32%) of 71 lung transplant recipients during a 4-year period of study. Surgical technique, endoscopic patterns, and mortality were reviewed retrospectively. Dehiscence was the most common anastomotic complication (18 episodes in 15 patients), followed by severe stenosis (n = 11) and anastomotic infection (n = 4; Aspergillus in three and cytomegalovirus in one). Dehiscence occurred with equal frequency in end-to-end anastomoses [10 (17%) of 59] as compared with telescoped anastomoses [8 (26%) of 31; p = NS]. However, all three instances of fatal dehiscence occurred in the end-to-end anastomosis group. Severe stenosis occurred more commonly in telescoped anastomoses [9 (29%) of 31] than in end-to-end anastomoses [2 (3%) of 59; p < 0.001]. Each of the seven instances of severe stenosis after dehiscence occurred in the telescoped anastomosis group. The lowest incidence of dehiscence [1 (7%) of 15] and severe stenosis (0 of 15) was seen in the subgroup of end-to-end anastomoses buttressed with pericardium, but the limited number of such anastomoses did not achieve statistical significance for comparisons. Airway dehiscence and severe stenosis remain important clinical problems after lung transplantation. Although the telescoped anastomosis appears to protect against fatal airway dehiscence, the overall incidence of dehiscence is not different when compared with the end-to-end anastomosis, and the incidence of severe stenosis is significantly higher.