Lung Transplantation: The State of the Airways

Abstract

Context: Lung transplantation has become a viable option for definitive treatment of several end-stage lung diseases for which there are no other options available. However, long-term survival continues to be limited by chronic lung allograft dysfunction, which primarily affects the airways.

Objective: To highlight the complications occurring mainly in the airways of the lung transplant recipient from the early to late posttransplant periods.

Data sources: Review literature focusing on the airways in patients with lung transplants and clinical experience of the authors.

Conclusions: Postsurgical complications and infections of the airways have decreased because of better techniques and management. Acute cellular rejection of the airways can be distinguished from infection pathologically and on cultures. Separating small from large airways need not be an issue because both are risk factors for bronchiolitis obliterans. Grading of airway rejection needs to be standardized. Chronic lung allograft dysfunction consists of both bronchiolitis obliterans and restrictive allograft syndrome, neither of which can be treated very effectively at present.