Successful bilateral lung transplantation from a deceased donor with a ruptured main bronchus

Major tracheobronchial trauma may lead to underestimation of the potential for lung donation due to insufficient alveolar ventilation and resulting poor oxygenation, bronchoscopic findings and radiographic findings (e.g. atelectasis). Here, we report a case of successful bilateral lung transplantation from a deceased donor whose right bronchus was ruptured by a trauma from the main bronchus to the bronchus intermedius. Although poor oxygenation and a collapsed right lung detected by computed tomography scanning precluded the use of the donor lungs by multiple transplant centres, careful bronchoscopic evaluation and intraoperative assessment convinced us that the parenchyma of the donor lungs was preserved sufficiently well for transplantation. Upon transplantation, the donor right bronchus was anastomosed at two levels, the upper lobe bronchus and the bronchus intermedius, and the lacerated portion was removed. The recipient's postoperative course was uneventful and the bronchial anastomoses healed excellently. Careful preoperative evaluation and appropriate surgical techniques might enable successful lung transplantation, using seemingly suboptimal donor lungs with major airway trauma.