INTERMEDIATE-TERM RESULTS AFTER EN-BLOC DOUBLE-LUNG TRANSPLANTATION WITH BRONCHIAL ARTERIAL REVASCULARIZATION

Objective: Between May 1990 and January 1994, 18 patients underwent en bloc double-lung transplantation with tracheal anastomosis and bronch ial arterial revascularization. Because at that time it was already su ggested that chronic ischemia could be a contributing factor in occurr ence of obliterative bronchiolitis, the purpose of this study was to e valuate, with a follow-up ranging from 22 to 69 months, the midterm ef fects of bronchial arterial revascularization on development of oblite rative bronchiolitis. Results: Results were assessed according to trac heal healing, functional results, rejection, infection, and incidence of obliterative bronchiolitis. There were no intraoperative deaths or reexplorations for bleeding related to bronchial arterial revasculariz ation, but there were three hospital deaths and five late deaths, two of them related to obliterative bronchiolitis. According to the criter ia previously defined, tracheal healing was assessed as grade I, IIa, or IIb in 17 patients and grade IIIa in only one patient. Early angiog raphy (postoperative days 20 to; 40) demonstrated a patent graft in II of the 14 patients in whom follow-up information was obtained. Ten pa tients are currently alive with a 43-month mean follow up. Among the 1 5 patients surviving more than 1 gear, functional results have been ex cellent except in five in whom obliterative bronchiolitis has develope d and who had an early or late graft thrombosis. Furthermore, those pa tients had a significantly higher incidence of late acute rejection (p < 0.02), cytomegalovirus disease (p < 0.006), and bronchitis episodes (p < 0.0008) than patients free from obliterative bronchiolitis. Conc lusion: We conclude that besides its immediate beneficial effect on tr acheal healing, long-lasting revascularization was, at least in this s mall series, associated with an absence of obliterative bronchiolitis, thus suggesting but not yet proving the possible role of chronic isch emia in this multifactorial disease.