Large Airway Disease After Transplantation

Airway diseases after lung transplantation continue to be a source of morbidity and mortality despite significant advances in the surgical techniques, organ procurement, and the medical management of the recipient. The incidence of airway complications after lung transplantation ranges from 2–33%, even though most transplant centers have reported rates in the range of 7–8%. Several risk factors have been linked to the development of airway complications after lung transplantation, including surgical anastomosis techniques, hypoperfusion, pre- and posttransplant airway infections, donor and recipient factors, immunosuppressive agents, and organ preservation. The airway complications include stenosis, perioperative and postoperative bronchial infections, bronchial necrosis and dehiscence, excess granulation tissue, and tracheobronchomalacia. The most frequent airway complication after lung transplantation is bronchial stenosis. Anastomosis infection, necrosis, or dehiscence typically develop within the first month after lung transplantation. Airway complications after lung transplant can lead to increased costs, higher morbidity, and decreased quality of life. Airway complications can be prevented by early recognition and intervention of the specific airway lesion.