Surveillance bronchoscopy in diagnosis and management of complications post lung transplantation

Abstract

Over the past years, lung transplantation has become a viable treatment option for patients with a variety of end-stage lung diseases. The first human lung transplant procedure was performed in 1963, and the recipient survived 18 days, ultimately succumbing to renal failure and malnutrition1. Despite the outcome, this demonstrated that lung transplantation was technically feasible and that rejection could be averted with the available immunosuppressive agents, at least for a short time.Over the ensuing 15 years, few lung transplant procedures were performed, and the majority of recipients died perioperatively because of bronchial anastomotic complications. However, in 1981, the first successful heart-lung transplantation was performed for idiopathic pulmonary arterial hypertension2. This was followed in 1983 by the first successful single lung transplantation for idiopathic pulmonary fibrosis3 and in 1986 by the first double lung transplantation for emphysema4. These successes were attributed to improved surgical techniques and the advent of cyclosporine. Over the following several years, the number of lung transplant procedures performed rapidly increased. As reported by ISHLT, there were about 4554 adult lung transplants in 20165. Although advances in patient selection, organ preservation, surgical technique, immunosuppression, and postoperative intensive care have improved overall survival following lung transplantation, the mortality associated with post-lung transplantation airway complications remains between 2% and 4%6. Although this is a low attributable mortality, overall survival rates are reduced at 30 days, 90 days, 1 year, 3 years, and 5 years in lung transplant recipients experiencing airway complications. In Vietnam, in recent years following the success of state and ministerial level projects on kidney transplants, liver transplants, and heart transplants, many organ transplant centers in the country have paid attention to developing heart-lung transplantation and lung transplant. Through several empirical studies, it has had applications in humans such as "heart-lung transplant" from a brain-dead donor in Hue Central Hospital (July 20, 2015), "bilateral lung transplants from two living donors." for 7 years old patients with cystic fibrosis at 103 Military Medical University Hospital (February 21, 2017)," bilateral lung transplants from brain-dead donor "at 108 Military Central Hospital for diseases Patients with chronic obstructive pulmonary disease (February 26, 2018). Especially from December 2018 until now, Viet Duc Hospital has successfully performed 5 lung transplants from brain-dead donors. In the success of lung transplants, we also have a lot of difficulties in airway complications post-lung transplant. However, there are no research topics on this issue so we perform the research: “Surveillance bronchoscopy in diagnosis and management of complications post lung transplantation”. Objective: 1. To describe the characteristic of complications post lung transplantation. 2. To evaluate the efficacy and the safety of bronchoscopy in the management of complications post lung transplantation.