Severe ischemic injury to the proximal airway following lung transplantation: Immediate and long-term effects on bronchial cartilage

Ischemia due to interruption of the bronchial circulation has been recognized as a cause of immediate postoperative anastomotic dehiscence in lung and heart-lung transplant recipients. Since patients do not ordinarily survive such major ischemic insults, the long-term effects of airway ischemia and the differentiation of these effects from those of transplant rejection and infection have not been clearly defined. We describe a patient who suffered extensive airway ischemia, necrosis, and subsequent diffuse airway stenosis. Loss of the bronchial circulation with variable ischemia may be a major cause of late airway abnormality responsible for significant morbidity and mortality in transplant recipients.