Chest
Clinical Investigations: Lung TransplantationAspergillus and Endobronchial Abnormalities in Lung Transplant Recipients
Section snippets
Subjects
We reviewed the records of all patients who underwent lung or heart-lung transplantation at our institution between December 1991 and June 1999. This cohort included 38 patients (15 men and 23 women), with a mean ± SD age of 49.9 ± 9.9 years. In 31 cases, single lung transplantation was performed; in six instances, bilateral lung transplantation was done; and there was one heart-lung recipient. There were therefore a total of 44 anastomoses in the study group. These were performed end to end
Results
Aspergillus was isolated in a total of 9 of 38 patients (23.7%). All isolates were of the Aspergillus fumigatus subtype. Endobronchial complications were diagnosed in seven patients (18.4%). Of these, two patients developed a stricture and five patients developed EGT. A typical example of the latter is shown in Figure 1. Six of the nine patients (66.6%) from the aspergillus cohort developed airway complications, as compared to 1 of 29 patients (3.4%) in whom aspergillus was not isolated (p =
Discussion
Endobronchial narrowing resulting in flow limitation after lung transplantation mostly takes the form of stricture formation at the bronchial anastomosis. These have a reported incidence of anywhere from 0 to 15%.1234 It is believed that anastomotic problems are related to bronchial ischemia, since the bronchial circulation is sacrificed during the transplant procedure. It is unlikely that ischemia is the only factor in bronchial anastomotic problems, since the reported incidence with
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All work was performed at Inova Fairfax Hospital.