Airway complications following pediatric lung and heart-lung transplantation

Obstruction at the airway anastomosis is a recognized complication of adult heart-lung transplantation (HLT) and lung transplantation (LT). Data for p ediatric transplantation have been scarce. We reviewed our experience in pe diatric HLT and LT to determine the frequency of airway complications and t o document the therapeutic modalities used for their treatment. Fifty-three patients (median age: 13.8 yr; range: 1.3 to 28.2 yr) underwent HLT (n = 2 5), SLT (n = 3), DLT (n = 25), or repeat DLT (n = 3) and survived for more than 72 h. Major anastomotic airway complications requiring intervention af fected one of the 25 HLT (4%) and seven of the 28 LT (SLT + DLT) patients ( 25%) (p = 0.05). Four patients with granulation tissue occluding the airway were treated with forceps resection, laser ablation, or balloon dilatation . Three patients with fibrotic strictures received silicone stents, laser a blation, or balloon dilatation. Two patients with bronchomalacia or diffuse stricture below the anastomosis underwent metal stent placement. Five of s even patients who were treated for anastomotic complications had satisfacto ry relief of airway obstruction. As compared with previously studied adults , pediatric heart-lung transplant recipients had the same or a lower freque ncy, and pediatric lung transplant recipients had a higher frequency of maj or anastomotic airway complications. A variety of treatment modalities were necessary to achieve adequate relief of airway obstruction.