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Anastomotic Airway Complications after Lung Transplantation.

Cho EN, Haam SJ, Kim SY, Chang YS, Paik HC - Yonsei Med. J. (2015)

Bottom Line: Five others were found to have stenosis at the bronchus intermedius, distal to the anastomosis site.Three of these patients showed improvement after ballooning or bronchoplasty.By serial surveillance via FBS after LTx, we detected anastomotic airway complications in 42.9% of cases, which were successfully managed with improved clinical outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Anastomotic airway complications are a major cause of morbidity and mortality after lung transplantation (LTx). In this study, the authors identified types and clinical outcomes of airway complications after LTx.

Materials and methods: All bronchial anastomotic complications were analyzed in a total of 94 LTx cases involving 90 recipients who underwent surgery between July 2006 and May 2014. Fifteen LTx cases (14 recipients) with incomplete medical records for fiberoptic bronchoscopy (FBS) and three cases underwent heart-lung transplantation (HLT) were excluded. Postoperative FBS at 24-48 hours, 1, 3, 6, and 12 months, and then yearly after the transplantation were performed.

Results: A total of 76 LTx cases (75 recipients) were analyzed. The mean age of the recipients was 49.55 years (range, 18-71 years), and 38 (49.4%) were male. Twenty-one out of 76 cases (27.6%) experienced early anastomotic complications, and 12 (15.8%) presented late anastomotic complications. The early anastomotic airway complications presented in various forms: stenosis, 1 case; narrowing, 1; necrosis & dehiscence, 3; fistula, 4; granulation, 10; and infection, 2. Late complications almost entirely presented in the form of bronchial stenosis; five recipients showed stenosis at the anastomosis site, and one of them showed improvement after ballooning. Five others were found to have stenosis at the bronchus intermedius, distal to the anastomosis site. Three of these patients showed improvement after ballooning or bronchoplasty.

Conclusion: By serial surveillance via FBS after LTx, we detected anastomotic airway complications in 42.9% of cases, which were successfully managed with improved clinical outcomes.

No MeSH data available.


Related in: MedlinePlus

Diagram of the study cases. Since July 1996, a total 90 patients (94 LTx cases) underwent LTx. Among 90 recipients, 18 LTx cases were excluded from this analysis. Among 76 LTx cases (75 recipients), 21 recipients showed early anastomotic complications and 12 late complications. LTx, lung transplantation; FOB, fiberoptic bronchoscopy; PFT, pulmonary function test.
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Figure 1: Diagram of the study cases. Since July 1996, a total 90 patients (94 LTx cases) underwent LTx. Among 90 recipients, 18 LTx cases were excluded from this analysis. Among 76 LTx cases (75 recipients), 21 recipients showed early anastomotic complications and 12 late complications. LTx, lung transplantation; FOB, fiberoptic bronchoscopy; PFT, pulmonary function test.

Mentions: A total of 94 LTx in 90 recipients who underwent surgery between July 2006 and May 2014 were collected, and 76 LTx cases (75 recipients) who had no identifiable problems during this time period underwent further analysis (Fig. 1). The mean age of recipients was 49.55 years (range, 18-71 years), and 38 (49. 4%) were male. Seven out of 76 underwent single LTx, and the remaining 69 cases were bilateral LTx. Twenty-four out of 76 (31.6%) were diagnosed as chronic obstructive pulmonary disease (COPD) using a pre-operative pulmonary function test. As LTx recipients showed obstructive patterns of flow-volume loop, indicating variant underlying causes such as bronchiectasis (non-cystic fibrosis), interstitial pulmonary fibrosis (IPF), or lymphangioleiomyomatosis (LAM), we classified subjects by pathological diagnosis. IPF was the leading cause of LTx, accounting for 36 cases, followed by LAM (13 cases), bronchiectasis (non-cystic fibrosis; eight cases), diffuse alveolar damage (four cases), diffuse panbronchiolitis (two cases), Eisenmenger syndrome (one case), interstitial lung disease related to connective tissue disease (four cases), bronchiolitis obliterance (BO) after bone marrow transplantation (BMT; five cases), and three other cases (Table 1). Twenty-one out of 76 recipients (27. 6%) experienced early anastomotic airway complications and 12 (15.8%) experienced late complications. Forty-four LTx cases (43 recipients) did not show complications at anastomosis sites during the follow-up period. In comparing recipients who suffered airway complications with those who did not, there were no statistical differences in age, gender, or ratio of donor-recipient total lung capacity. Recipients who suffered from IPF or bronchiectasis (non-cystic fibrosis) experienced airway complications more frequently than other disease subgroups. Among 33 LTx cases with anastomotic airway complications, one recipient with dehiscence died as a result of anastomotic airway complications.


Anastomotic Airway Complications after Lung Transplantation.

Cho EN, Haam SJ, Kim SY, Chang YS, Paik HC - Yonsei Med. J. (2015)

Diagram of the study cases. Since July 1996, a total 90 patients (94 LTx cases) underwent LTx. Among 90 recipients, 18 LTx cases were excluded from this analysis. Among 76 LTx cases (75 recipients), 21 recipients showed early anastomotic complications and 12 late complications. LTx, lung transplantation; FOB, fiberoptic bronchoscopy; PFT, pulmonary function test.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541669&req=5

Figure 1: Diagram of the study cases. Since July 1996, a total 90 patients (94 LTx cases) underwent LTx. Among 90 recipients, 18 LTx cases were excluded from this analysis. Among 76 LTx cases (75 recipients), 21 recipients showed early anastomotic complications and 12 late complications. LTx, lung transplantation; FOB, fiberoptic bronchoscopy; PFT, pulmonary function test.
Mentions: A total of 94 LTx in 90 recipients who underwent surgery between July 2006 and May 2014 were collected, and 76 LTx cases (75 recipients) who had no identifiable problems during this time period underwent further analysis (Fig. 1). The mean age of recipients was 49.55 years (range, 18-71 years), and 38 (49. 4%) were male. Seven out of 76 underwent single LTx, and the remaining 69 cases were bilateral LTx. Twenty-four out of 76 (31.6%) were diagnosed as chronic obstructive pulmonary disease (COPD) using a pre-operative pulmonary function test. As LTx recipients showed obstructive patterns of flow-volume loop, indicating variant underlying causes such as bronchiectasis (non-cystic fibrosis), interstitial pulmonary fibrosis (IPF), or lymphangioleiomyomatosis (LAM), we classified subjects by pathological diagnosis. IPF was the leading cause of LTx, accounting for 36 cases, followed by LAM (13 cases), bronchiectasis (non-cystic fibrosis; eight cases), diffuse alveolar damage (four cases), diffuse panbronchiolitis (two cases), Eisenmenger syndrome (one case), interstitial lung disease related to connective tissue disease (four cases), bronchiolitis obliterance (BO) after bone marrow transplantation (BMT; five cases), and three other cases (Table 1). Twenty-one out of 76 recipients (27. 6%) experienced early anastomotic airway complications and 12 (15.8%) experienced late complications. Forty-four LTx cases (43 recipients) did not show complications at anastomosis sites during the follow-up period. In comparing recipients who suffered airway complications with those who did not, there were no statistical differences in age, gender, or ratio of donor-recipient total lung capacity. Recipients who suffered from IPF or bronchiectasis (non-cystic fibrosis) experienced airway complications more frequently than other disease subgroups. Among 33 LTx cases with anastomotic airway complications, one recipient with dehiscence died as a result of anastomotic airway complications.

Bottom Line: Five others were found to have stenosis at the bronchus intermedius, distal to the anastomosis site.Three of these patients showed improvement after ballooning or bronchoplasty.By serial surveillance via FBS after LTx, we detected anastomotic airway complications in 42.9% of cases, which were successfully managed with improved clinical outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Anastomotic airway complications are a major cause of morbidity and mortality after lung transplantation (LTx). In this study, the authors identified types and clinical outcomes of airway complications after LTx.

Materials and methods: All bronchial anastomotic complications were analyzed in a total of 94 LTx cases involving 90 recipients who underwent surgery between July 2006 and May 2014. Fifteen LTx cases (14 recipients) with incomplete medical records for fiberoptic bronchoscopy (FBS) and three cases underwent heart-lung transplantation (HLT) were excluded. Postoperative FBS at 24-48 hours, 1, 3, 6, and 12 months, and then yearly after the transplantation were performed.

Results: A total of 76 LTx cases (75 recipients) were analyzed. The mean age of the recipients was 49.55 years (range, 18-71 years), and 38 (49.4%) were male. Twenty-one out of 76 cases (27.6%) experienced early anastomotic complications, and 12 (15.8%) presented late anastomotic complications. The early anastomotic airway complications presented in various forms: stenosis, 1 case; narrowing, 1; necrosis & dehiscence, 3; fistula, 4; granulation, 10; and infection, 2. Late complications almost entirely presented in the form of bronchial stenosis; five recipients showed stenosis at the anastomosis site, and one of them showed improvement after ballooning. Five others were found to have stenosis at the bronchus intermedius, distal to the anastomosis site. Three of these patients showed improvement after ballooning or bronchoplasty.

Conclusion: By serial surveillance via FBS after LTx, we detected anastomotic airway complications in 42.9% of cases, which were successfully managed with improved clinical outcomes.

No MeSH data available.


Related in: MedlinePlus