Bronchial anastomotic complications following lung transplantation: still a major cause of morbidity?

The frequency of bronchial anastomotic complications following lung transplantation has decreased in recent years, but continues to be a potential cause of morbidity and mortality. We have, therefore, reviewed the results of 67 consecutive bronchial anastomoses at risk in 43 patients surviving more than 7 days following lung transplantation. The bronchial anastomoses were performed using a standardized technique, without direct or indirect revascularization. Regular triple immunosuppressive therapy was given, including prednisone (0.5 mg x kg(-1) daily) starting on the day of surgery. Bronchial healing was graded using the Couraud classification. The median follow-up time was 14 months (range 1-45 months). No major airway complications occurred. On 236 serial bronchoscopic examinations, no anastomotic stenoses were observed. One anastomosis showed limited focal necrosis (2 mm) (Couraud 3a), and two anastomoses had partial primary mucosal healing without necrosis (Couraud 2a). In all other anastomoses, primary mucosal healing (Couraud 1) was observed. Carefully performed bronchial anastomosis according to the technique described enables reliable bronchial healing and yields a low complication rate. Additional measures, such as direct revascularization, forced telescoping, omentum wrap and interruption of steroid therapy, are not necessary.