[Diffuse bronchomalacia after double lung transplantation. Thoughts apropos of a case]

A 40 year old woman suffered from respiratory insufficiency (arterial PaO2 = 47 mmHg) because of a chronic beryllium intoxication. On 6th June 1990, she underwent double lung transplantation with cardio-pulmonary bypass. Each lung was separately implanted via an extra-pericardial approach, and both bronchi were anastomosed at the hilum. On the seventh post operative day, a severe bilateral bronchial ischemia was noticed (black mucosa). Few weeks later, a diffuse bronchomalacia was noticed in the proximal and distal parts of both bronchial trees. To our knowledge, such a bronchial post-ischemic complication has never been reported. The explantation could be several added causes: imperfect preservation of the lung during harvesting, post operative pulmonary oedema, and operative use of an antifibrinolytic agent (aprotinin).