Airway complications after lung transplantation can be avoided without bronchial artery revascularization

The major cause of death following lung transplantation in the beginning after the first human lung transplantation in 1963 was airway dehiscence, representing a major obstacle to widespread use of this treatment option. Lung transplantation is unique among all solid organ transplantations, since systemic arterial blood supply is not restored during engraftment. In the eighties and thereafter the problem of airway healing after lung transplantation was the main focus of research. This review focuses on the incidence of airway anastomotic complications after lung transplantation and delineates potential risk factors.

Refinements in lung preservation and surgical technique have reduced the incidence of airway complications. Reflecting these changes, the contemporary rate of anastomotic lesions following lung transplantation has dropped from 80% before 1983 to less than 3% with a range of 2.6-23.8%. Small clinical series of lung transplantation with direct bronchial artery revascularization have reported promising early results. However, direct bronchial artery revascularization has been considered a difficult and unreliable method to be used clinically, as it prolongs the operation and ischemic time, increases risk of bleeding, and because of the good results reported from transplants without bronchial artery revascularization. At the present time (nearly) all transplant centers perform the airway anastomosis without bronchial artery revascularization.

Bronchial anastomotic complications can be avoided by use of a standardized surgical technique which respects the fact that the donor bronchus is poorly vascularized. Prevention of fungal infections with aggressive antifungal treatment may play an important additive role.