Management of airway dehiscence post lung transplantation a case series.

A. Hanna*^a (Dr), A. Crutu^a (Dr), P. Baldeyrou^a (Dr), D. Fabre^b (Prof), O. Mercier^b (Prof), J. Le Pavec^a (Dr), E. Fadel^b (Prof)

^a Interventional bronchoscopy unit, Department of Pulmonary medicine and Lung Transplantation, Marie Lannelongue Hospital., Le Plessis Robinson, FRANCE ; ^b Department of Thoracic, Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital., Le Plessis Robinson, FRANCE

* amirkmaurice@gmail.com

Introduction:

Airway dehiscence increases the mortality and morbidity and impacts the outcome of transplantation in this population. We will hereby present a case series of airway dehiscence management following lung transplantation.

Case presentation:

Case 1:

A 46 years old patient who had a double-lung transplantation for idiopathic pulmonary hypertension. Five weeks after transplantation she developped a necrosis with dehiscence of the donor’s left main bronchus. CT chest showed a loss of left main bronchus integrity. Bronchoscopy and successful left main bronchus stenting using a covered metallic stent 12x40 mm. Patient was weaned from mechanical ventilator few days later and stent was removed 7 weeks later.

Case 2:

A 51 years old patient who developped a bilateral airway dehiscence 8 weeks post double-lung transplantation. CT chest showed loss of integrity of the two main bronchus. Fiberoptic bronchoscopy revealed bilateral incomplete dehiscence. Successful bilateral airway stenting using a covered metallic stent (12x30 mm) for the left main bronchus, and (12x20 mm) for the right main bronchus. Successful weaning few days later and stents removed 8 weeks later.

Case 3:

A 46 years old patient who had a double-lung transplantation complicated with a right pleuro esophageal fistula, surgically repaired. She then developed a bilateral complete airway dehiscence. The left bronchial dehiscence was surgically repaired, while the right was endoscopically managed using a covered metallic stent 12x20 mm. She developed a complete atelectasis of the left lower lobe due to a punctiform bronchus. Successful covered metallic stent 8x15 mm of the left lower lobe. The right bronchus stent was removed 6 weeks later and the left 5 months after.

Conclusion:

Airway dehiscence following lung transplantation is a challenging complication to manage. Management as airway stenting and redo surgery if indicated should be discussed on a case by case basis, and needs a multidisciplinary approach.

Disclosure of funding source(s): none