Atemwegskomplikationen nach Lungentransplantation – Klinik, Diagnose und interventionelle Behandlung

Zusammenfassung

Bei den tracheobronchialen Komplikationen handelt es sich um lokale strukturelle oder infektiöse Veränderungen der Atemwege, die sich unmittelbar (Frühkomplikationen) sowie im Verlauf von mehreren Monaten oder Jahren (Spätkomplikationen) nach Lungentransplantation (LTx) manifestieren können. Atemwegskomplikationen entwickeln sich bevorzugt im Bereich der Anastomosen. Hierzu gehören die bronchiale Stenose und Anastomosendehiszens, exophytisches Granulationsgewebe, tracheobronchiale Malazie, bronchiale Fisteln sowie endobronchiale Infektionen. Ursache ist eine Ischämie des Spenderbronchus in den Wochen nach LTx aufgrund der gestörten postoperativen Atemwegsperfusion. Zu den Risikofaktoren für die Entwicklung von Atemwegskomplikationen gehören ferner perioperative Infektionen, Operationstechnik, Immunsuppression. Die Therapie der LTx-assoziierten Atemwegskomplikationen bedarf frühzeitiger bronchiologischer Interventionen, zu denen die Ballon-Bronchoplastie, Kryotherapie, Laserphotoresektion, endobronchiale Brachytherapie und Stentimplantation gehören. Darüber hinaus können eine antibiotische Behandlung oder eine nicht-invasive positive-Druck-Beatmung erforderlich werden. Die jeweils erforderlichen Maßnahmen sind abhängig von Zeitpunkt, Typ und klinischer Relevanz der Komplikation. Die nachfolgende Übersicht stellt klinische Präsentation, Risikofaktoren, diagnostische Techniken und Behandlungsformen für die häufigsten LTx-assoziierten Atemwegskomplikationen dar.

Abstract

Tracheobronchial complications following lung transplantation are defined as local structural or infectious alterations of the airways, which occur early or several months after lung transplantation (LTx). They preferentially develop in the region of the bronchial anastomosis. The most frequently reported complications are bronchial stenosis, bronchial dehiscence, exophytic excessive granulation tissue formation, tracheo-bronchomalacia, bronchial fistulas, and endobronchial infections. Airway complications are mainly attributed to ischaemia of the donor bronchus during the immediate post-transplant period. The most relevant risk factors for the development of airway complications include local infections, surgical techniques, and the immunosuppressive regimen. Thus, management of post-transplant bronchial complications requires early interventional bronchoscopic procedures including balloon bronchoplasty, cryotherapy, laser photoresection, endobronchial brachytherapy, and bronchial stents. In addition, antibiotic treatment, or non-invasive positive-pressure ventilation may be necessary. The procedures required depend on the time of occurrence, the type, and clinical relevance of the airway complication. This review summarises clinical presentation, risk factors, the diagnostic methods as well as management options for the most common LTx-associated airway complications.

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Bisher erschienene Beiträge dieser Serie

• 50 Schreder T et al. Lungentransplantation bei Lungenemphysem – Wer? Wann? Wie?.  Pneumologie. 2010;  64 632-639
• 51 Neurohr C et al. Immunsuppression und Infektionsprophylaxe nach Lungentransplantation.  Pneumologie. 2011;  65 94-102