Vanishing Bronchus Syndrome After Lung Transplantation: Clinical Characteristics, Airway Colonization, and Stent Outcomes

IF 1.8 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2026-10-06 DOI:10.1111/ctr.70707

Hirotsugu Notsuda, Sakiko Kumata, Ken Onodera, Tatsuaki Watanabe, Yui Watanabe, Takashi Hirama, Takaya Suzuki, Hisashi Oishi, Yoshinori Okada

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Abstract

Background

Airway complications remain a significant cause of morbidity after lung transplantation. Among them, vanishing bronchus syndrome (VBS) represents a severe form of airway injury characterized by progressive distal bronchial stenosis. Although ischemia has been implicated in its pathogenesis, the role of airway colonization with multidrug-resistant organisms remains incompletely understood.

Materials and Methods

We conducted a retrospective, single-center study of lung transplant recipients who developed VBS between January 2001 and November 2025. Clinical characteristics, bronchoscopic findings, microbiological data, and outcomes following airway stenting were reviewed. VBS was defined as progressive bronchial stenosis predominantly involving the distal airway beyond the bronchial anastomosis. Associations between airway infection, stent outcomes, and airway healing were evaluated.

Results

Among 203 lung transplant recipients, five patients (2.5%) developed VBS requiring airway stenting. All patients demonstrated stenosis involving the bronchus intermedius. Multidrug-resistant organisms, including methicillin-resistant Staphylococcus aureus, were detected in two patients, both of whom remained stent-dependent. In contrast, three patients without multidrug-resistant organisms ultimately achieved successful stent removal with sustained airway patency. However, long-term stent dependency was also influenced by persistent structural airway abnormalities and stent-related factors.

Conclusions

VBS may involve a complex interplay among ischemic injury, structural airway abnormalities, stent-related factors, and microbial colonization. Persistent multidrug-resistant airway colonization may be associated with unfavorable airway outcomes; however, its independent contribution remains uncertain.

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肺移植后支气管消失综合征：临床特征、气道定植和支架结果。

背景：气道并发症仍然是肺移植术后发病的重要原因。其中，消失支气管综合征（VBS）是一种以进行性远端支气管狭窄为特征的严重气道损伤。尽管缺血与其发病机制有关，但多药耐药生物在气道定殖中的作用仍不完全清楚。材料和方法：我们对2001年1月至2025年11月期间发生VBS的肺移植受者进行了回顾性、单中心研究。本文回顾了临床特征、支气管镜检查结果、微生物学数据和气道支架植入术后的结果。VBS被定义为进行性支气管狭窄，主要累及支气管吻合口以外的远端气道。评估气道感染、支架结果和气道愈合之间的关系。结果：203例肺移植受者中，5例（2.5%）发生了需要气道支架植入的VBS。所有患者均表现为累及中间支气管的狭窄。包括耐甲氧西林金黄色葡萄球菌在内的多重耐药生物在两名患者中被检测到，这两名患者仍然依赖支架。相比之下，3名无多药耐药菌的患者最终成功移除支架并维持气道通畅。然而，长期支架依赖也受到持续性气道结构性异常和支架相关因素的影响。结论：VBS可能涉及缺血性损伤、气道结构异常、支架相关因素和微生物定植之间的复杂相互作用。持续的多药耐药气道定植可能与不利的气道结局有关；然而，其独立贡献仍不确定。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.