European Journal of Cardio-Thoracic Surgery, Vol 10, 521-526, Copyright © 1996 by European Association for Cardio-thoracic Surgery
Healing of the bronchus in pulmonary transplantation
IC Wilson, A Hasan, M Healey, J Villaquiran, PA Corris, J Forty, CJ Hilton and JH Dark
Cardiopulmonary Transplant Unit, Freeman Hospital, Newcastle-upon-Tyne, England.
OBJECTIVE: To review the results of bronchial healing in a consecutive
series of 100 isolated pulmonary transplants, performed at one centre
between 1987 and 1994. METHODS: A retrospective review of 123 assessable
bronchi (61 in single lung and 62 in bilateral lung) transplants was
carried out. All anastomoses were assessed by bronchoscopy at 7-10 days,
and follow up was from one to seven years. The effect on bronchial
dehiscence or stenosis requiring endobronchial stent, of suture technique,
pre and post operative steroid administration, bronchial wrap, donor
ischaemic time and time to first rejection episode was assessed. RESULTS:
Complications of airways healing occurred in four patients: stenosis in two
and dehiscence in two (1.6% of bronchi at risk in both groups). Airway
complication was not affected by steroids, pre-operative diagnosis,
presence of a wrap (34 with pericardium or omentum, 89 with peribronchial
tissue alone) or any other variable. There was a higher incidence of
dehiscence (2/36) with continuous rather then interrupted (0/87) suture,
but this was not statistically significant. There was one airway-related
death. Two patients who required anastomotic stenting remain alive and
well. CONCLUSIONS: A very low complication rate can be achieved without
recourse to bronchial wrapping, telescoping anastomoses or steroid
avoidance. Combined heart-lung transplantation or bronchial
revascularisation are not required to achieve reliable bronchial healing.
