AIRWAY COMPLICATIONS IN LUNG TRANSPLANTATION

This article reviews the literature on airway healing after lung trans plantation. From a historical point of view, this has been the Achille s' heel of lung transplantation through two decades, from the first at tempt at single-lung transplantation in 1963 to the clinical successes in the early 1980s. The overall incidence of lethal airway complicati ons is estimated to be 2% to 3%, whereas that of late stricture is 7% to 14%. Comparison of experiences has been difficult without a univers al classification; a new classification for airway and anastomotic com plications and healing is proposed. Ischemia appears to be the most im portant factor influencing airway healing. Low-pressure collateral bro nchial blood now from the pulmonary artery may be affected by low card iac output, reperfusion edema, or rejection; mucosal injury may be fur ther increased by prolonged positive-pressure ventilation. Good bronch ial healing appears to be possible without a protective wrap and with early use of steroids. The management of bronchial complications is ch allenging and requires endoscopic skills including knowledge of endobr onchial laser photocoagulation and stent insertion techniques.