Anastomotic Airway Complications after Lung Transplantation

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.

Bronchial angiogenesis in bronchial asthma patients

An immunohistochemical study on bronchial biopsies taken from ten patients with severe asthma, ten patients with mild asthma and ten healthy normal control subjects was done using monoclonal antibodies identifying the vessel marker [EN-4], intercellular adhesion molecule [ICAM-1], vascular cell adhesion molecule [VCAM-I], E- and P-selectin. Bronchial biopsies from patients with severe asthma showed an increased number of subepithelial vessels, an increased size of vessels and an increased percentage of area covered with vessels as compared with mild asthma and control subjects which was correlated with airflow limitation [decreased FEV1% pred]. An increased number of vessels expressing ICAM-1 and a decreased number of vessels expressing E-selectin which was highly correlated to airflow limitation [decreased FEV1% pred, decreased PEFR% pred and FEV75% pred] were observed. No difference was found between the three groups in the expression of VCAM-1 and P-selectin

Problemas da anastomose brônquica na reimplantaçäo pulmonar: estudo experimental / Problems in bronchial anastomosis in lung reimplantation: an experimental study

Foram operados 26 caes, 14 com reimplantaçao pulmonar e 12 com "despleurizaçao hilar", para estudar alguns problemas decorrentes destas operaçoes, com destaque para a vascularizaçao arterial brônquica. Os resultados foram avaliados entre os 12 e os 24 meses, por intermédio de estudos in vivo (broncoscopias e exame bacteriológico das secreçoes brônquicas) e post-mortem (broncoarteriografias, moldes de injecçao-corrosao e exames anátomo-patológicos). Observaram-se 3 casos com complicaçoes pós-reimplante: 2 com bronquiectasias saculares sem aperto brônquico coexistente, e 1 com estenose da anastomose brônquica. Nos restantes animais nao se registraram alteraçoes. Em todos os casos observados, com ou sem complicaçoes, verificou-se o restabelecimento espontâneo de uma vascularizacao brônquica normal. Atribui-se à desnervaçao decorrente do reimplante um papel significativo na etiopatogenia das bronquiectasias; e em face da vascularizaçao brônquica normal e da ausência de infecçao no enxerto, considera-se que a estenose foi determinada por pequenos defeitos de técnica cirúrgica, dada a tendência que a mucosa tem em retrair-se depois da secçao do brônquio e que é considerada como um fator de desenvolvimento de fibrose. Valoriza-se o papel da circulaçao venosa pulmonar, com sangue arterializado, na revascularizaçao do coto do "brônquio dador".