Decreased incidence of bronchial complications following lung transplantation

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Abstract
Despite omental wrap and avoidance of prophylactic administration ofcorticosteroids in the early postoperative phase, ischemic bronchialcomplications still represent an important source of early morbidity andmortality following lung transplantation. In a retrospective analysis, theeffect of pharmacological enhancement of pulmonary collateral flow onbronchial healing was investigated. Thirty-nine consecutive unilateral orbilateral transplant procedures (Tx) were analyzed. Immunosuppressionconsisted of rabbit antithymocyte globulin (RATG), cyclosporine A, andazathioprine. In group 1 (10 Tx, 12 anastomoses) routine immunosuppressionwas employed and the anastomoses wrapped with an omental or pericardialpedicle. In group 2 (29 Tx, 41 anastomoses) PGI2 (4 ng/kg per min x 48 h),heparin (200 U/kg per day), and prednisolone (0.5 mg/kg per day) were addedto the therapeutic regimen. The 2 groups were comparable with respect toage and sex of the patients, primary diagnosis, type of transplant,intraoperative use of extracorporeal circulation, graft ischemia, durationof mechanical ventilation, and mortality. Bronchoscopic evidence of asignificant bronchial ischemia (extending more than 1 cartilaginous ringbeyond the anastomosis) was seen in 8 of 12 anastomoses in group 1 vs 14 of53 anastomoses in group 2 (P = NS). In group 1, significant bronchialstenosis required implantation of an endobronchial silicone stent in 6 of12 anastomoses, whereas in group 2, no significant bronchial stenosisoccurred (P less than 0.01). No negative effects possibly related to theprophylactic administration of corticosteroids could be observed.(ABSTRACTTRUNCATED AT 250 WORDS)

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