ABSTRACT
Objective To assess the efficacy of interventional bronchoscopic techniques used to treat stenosis of bronchial anastomosis after lung transplantation.Methods A retrospective study of 24 cases who underwent lung transplantation from September 2003 to August 2005 in our Unit was done. All recipients were subjected to surveillance bronchoscopy with biopsy at predetermined intervals and when clinically indicated. Endobronchial electrocauterization with microwave therapy apparatus and endobronchial electrocoagulation with high-frequency electrotome were performed for the management of bronchial stenosis or granuloma formation.Results There were 2 of 24 recipients (2/24,8.3 %) with stenosis of bronchial anastomosis. Airway stenosis appeared in 3 of 28 anastomoses (3/28,10.7 %): 2 on the left and 1 on the right. These patients with airway stenosis responded to interventional bronchoscopy,and their respiratory function was improved significantly.Conclusions Despite the improvements in surgical technique and immunosuppression strategies,a small number of patients still had airway complications after lung transplantation. Interventional bronchoscopic techniques,i.e. endobronchial electrocauterization with microwave therapy apparatus and endobronchial electrocoagulation with high-frequency electrotome will be effective in the treatment of airway complications after lung transplantation and with good response in respiratory function.
ABSTRACT
Objective To discuss the feasibility of the lung transplantation as an effective treatment for end-stage pulmonary diseases domestically and to compare the major issues involving the practice of lung transplantation domestically and overseas.Methods After the foundation of group of lung transplantation in May 2002, lung transplantation models of porcine were set up. From September 2002 to April 2005, in the 18 cases undergoing lung transplantation, there were subjected to single-lung transplantion (SLT, 83.3%) and 3 bilateral sequential single lung transplants without CPB (DSSLT, 16.7%). Indications for SLT (n=15) included emphysema (n=9), pulmonary fibrosis (n=3), pneumosilicosis (n=1), lymphangioleiomyomatosis (n=1) and ventricular septal defect (VSD) induced Eisenmenger's syndrome (n=1); for DSSLT (n=3) bronchiectasis (n=1) and pulmonary emphysema (n=2). Among the 15 SLTs, there were 9 cases of left SLT and 6 right SLT. Among them, 2 cases shared one same donor's lung block, one case received contralateral lung transplantation―a left donor lung implanted in the recipient’s right thorax, and one case simultaneous right SLT and VSD repair. Results In hospital mortality (HM) was 3/18 ( 16.7%). Among SLTs, early death was due to severe rejection on the 30th postoperative day in one patient and acute rejection on the 15th postoperative day in other patients, and another patient died due to pulmonary vein embolism on the 36th day. There were 3 and 2 patients with the survival time longer than 1 and 2 years respectively. The median overall survival was 10 (2 to 32) months. Conclusions Our LT program shows similar results to those reported by the International Society for Heart and Lung Transplantation for developed countries. The key of successful operation depends on the establishment of group of lung transplantation and cooperation of multi-department. Ischemic-reperfusion injury, acute-rejection and infection are the major reasons of deaths shortly after the operations.