IMPROVED AIRWAY HEALING AFTER LUNG TRANSPLANTATION - AN ANALYSIS OF 348 BRONCHIAL ANASTOMOSES

Ve evaluated various clinical factors to identify predictors of airway complication after lung transplantation. Two hundred twenty-nine cons ecutive single (n = 110) and bilateral (n = 119) lung transplants were done between September 1988 and August 1991. These 338 bronchial anas tomoses were retrospectively analyzed. Airway complication that necess itated clinical intervention affected 33 anastomoses (9.5%) in 29 pati ents (12.8%), Satisfactory healing was achieved in 22 of these patient s by conservative therapy such as one or a combination of dilation, st ent, and laser. There were five deaths (2.2%) attributable to airway c omplications. One patient had an early postoperative death unrelated t o airway complication and one patient has a recalcitrant bronchus inte rmedius stricture. Complication occurred more often in single-lung tha n in bilateral lung transplants (16/110, 14.4%, versus 17/238, 7.1%; p < 0.05). The use of a mattress suture (21/153, 13.7%) was associated with more frequent complications than was simple interrupted suture (8 /122, 6.6%) or figure-of-eight suture (4/73, 5.5%) (p < 0.05). For pat ients in whom airway complications subsequently developed, the duratio n of postoperative mechanical ventilation was greater than that for th ose in whom an airway complication did not develop. The prevalence of airway complications as our program evolved was evaluated by separatin g the 229 transplants into three groups: phase I, the first 77 transpl ants; phase II, the next 76 transplants; and phase III, the most recen t 76 transplants. The airway complication rate per anastomosis was sig nificantly lower in phase III (5/126, 4.0%) than in phase I (12/110, 1 0.9%; p < 0.05) and phase II (16/112, 14.3%; p < 0.01), The majority o f airway complications are successfully treated and rarely fatal. The recent reduction in prevalence of airway complications is Likely a res ult of better maintenance immunosuppression and rejection surveillance .