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Airway complications after lung transplantation

Marcelo Cypel, MD, MSc, FRCSC
Tom Waddell, MD, MSc, PhD, FRCS, FACS
Shaf Keshavjee, MD, MSc, FRCSC, FACS
Section Editor
Elbert P Trulock, MD
Deputy Editor
Helen Hollingsworth, MD


During lung transplantation, the airway anastomosis is typically performed between the bronchus of the donor lung and that of the recipient. The airway anastomosis has traditionally been the most vulnerable site for operative complications of lung transplantation. Airway anastomotic complications include focal infection, bronchial necrosis and dehiscence, excess granulation tissue, tracheobronchomalacia, stenosis, and fistula formation.

The pathogenesis, diagnosis, treatment, and prevention of airway anastomotic complications of lung transplantation will be reviewed here. Other airway complications, such as bacterial and viral tracheobronchitis and bronchiolitis obliterans, and noninfectious problems related to lung transplantation are discussed separately. (See "Bacterial infections following lung transplantation" and "Chronic lung transplant rejection: Bronchiolitis obliterans" and "Noninfectious complications following lung transplantation".)


Anastomotic airway complications after lung transplantation include those that typically develop within the first month (eg, anastomotic infection, necrosis, or dehiscence) and those that develop later (eg, excess granulation tissue, bronchomalacia, airway stenosis, bronchopleural fistula, bronchomediastinal fistula, or bronchovascular fistula) (table 1) [1].

Limited mucosal necrosis and sloughing at the anastomotic site are commonly observed during bronchoscopy in the first two to three weeks after transplant. These mild mucosal changes are not usually considered an "airway complication," if satisfactory healing occurs without intervention. Complications are considered significant when they necessitate an intervention such as debridement, dilatation, or stent placement.


Reported incidences of airway anastomotic complications range from 2 to 33 percent, although most centers have rates in the range of 7 to 18 percent [1-3]. In a retrospective series of 232 lung transplants, 57 airway complications developed; the majority occurred in the first post-transplant year [2].

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Literature review current through: Nov 2017. | This topic last updated: Apr 29, 2016.
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