Abstract
Following lung transplantation, bronchial healing is one of the main factors contributing to a good functional result. We aimed at identifying factors influencing bronchial healing following lung transplantation.
We conducted a historical study from 2004 to 2014 in our center including all lung tranplantations. Demographic characteristics of recipients and donors, immunosuppressive regimens, and surgical technique for anastomosis were studied over time. Bronchial complications with clinical impact were recorded: bronchial dehiscence, hemoptysis and death, fistula and prolonged air leak, need for surgical repair, stenosis and need for repeated dilations.
We recorded 262 lung transplants (211 bilateral and 51 single lung procedures). Overall, 18% of recipients presented with bronchial complications; in the latter, 8 patients died from hemoptysis. We found no difference inbetween the recipients, the donors, or lung ischemia. After 2009, the switch of immunosuppressive regimen to basiliximab/tacrolimus/mycophenolate/steroids resulted in a significantly increased number of bronchial complications (25%;p=0.03). From 2011, the surgical technique was modified to a wedge resection on the bronchius intermedius before anastomosis resulting in a significant decrease of bronchial complications (12%;p=0.02) though using the same unmodified immunosuppressive regimen. Overall, patients with primary graft dysfunction (n=74) presented with more bronchial complications (p=0.03)
Primary graft dysfunction is a favoring factor for bronchial complications.The modified surgical technique enabled us to significantly decrease the negative impact of immunosuppressive regimen on bronchial healing.
- Copyright ©ERS 2015
