HEALING OF THE BRONCHUS IN PULMONARY TRANSPLANTATION

Objective. To review the results of bronchial healing in a consecutive series of 100 isolated pulmonary transplants, performed at one centre between 1987 and 1994. Methods. A retrospective review of 123 assessa ble bronchi (61 in single lung and 62 in bilateral lung) transplants w as carried out. All anastomoses were assessed by bronchoscopy at 7-10 days, and follow up was from one to seven years. The effect on bronchi al dehiscence or stenosis requiring endobronchial stent, of suture tec hnique, pre and post operative steroid administration, bronchial wrap, donor ischaemic time and time to first rejection episode was assessed . Results. Complications of airways healing occurred in four patients: stenosis in two and dehiscence in two (1.6% of bronchi at risk in bot h groups). Airway complication was not affected by steroids, pre-opera tive diagnosis, presence of a wrap (34 with pericardium or omentum, 89 with peribronchial tissue alone) or any other variable. There was a h igher incidence of dehiscence (2/36) with continuous rather then inter rupted (0/87) suture, but this was not statistically significant. Ther e was one airway-related death. Two patients who required anastomotic stenting remain alive and well. Conclusions. A very low complication r ate can be achieved without recourse to bronchial wrapping, telescopin g anastomoses or steroid avoidance. Combined heart-lung transplantatio n or bronchial revascularisation are not required to achieve reliable bronchial healing.