BRONCHIAL ANASTOMOTIC COMPLICATIONS FOLLOWING LUNG TRANSPLANTATION - STILL A MAJOR CAUSE OF MORBIDITY

The frequency of bronchial anastomotic complications following lung tr ansplantation has decreased in recent years, but continues to be a pot ential cause of morbidity and mortality. We have, therefore, reviewed the results of 67 consecutive bronchial anastomoses at risk in 43 pati ents surviving more than 7 days following lung transplantation, The br onchial anastomoses were performed using a standardized technique, wit hout direct or indirect revascularization. Regular triple immunosuppre ssive therapy was given, including prednisone (0.5 mg.kg(-1) daily) st arting on the day of surgery, Bronchial healing was graded using the C ouraud classification, The median an follow-up time was 14 months (ran ge 1-45 months), No major airway complications occurred, On 236 serial bronchoscopic examinations, no anastomotic stenoses were observed, On e anastomosis showed limited focal necrosis (2 mm) (Couraud 3a), and t wo anastomoses had partial primary mucosal healing without necrosis (C ouraud 2a), In all other anastomoses, primary mucosal healing (Couraud 1) was observed, Carefully performed bronchial anastomosis according to the technique described enables reliable bronchial healing and yiel ds a low complication rate, Additional measures, such as direct revasc ularization, forced telescoping, omentum wrap and interruption of ster oid therapy, are not necessary.