Large airway complications following lung transplantation

Airway complications following lung transplantation are common and may be associated with significant morbidity and mortality. Although there are multiple risk factors, anastomotic ischemia is the major factor for the development of airway complications. Most of the complications can be managed with bronchoscopic interventions. However, some may require surgical intervention even retransplantation. In recent years, a universally accepted definition and grading system have been published by the International Society for Heart and Lung Transplantation (ISHLT). Common airway complications include anastomotic dehiscence, anastomotic infection, bronchomalacia, anastomotic stenosis, bronchial fistula, and granulation tissue formation. Although there is no accepted and standardized treatment for each airway complication, mainly due to lack of prospective and randomized studies, a number of various bronchoscopic interventions have been found to be effective. Although our understanding of the pathophysiology of airway complications and its management strategies are evolving, airway complications continue to be a challenging issue for surgeons, pulmonologists, and patients.