Vanishing middle bronchus in bilateral lung transplant after ex vivo lung perfusion

Lung transplant has become the mainstay of therapy for most end-stage lung diseases. Airway com-plications are one of the most important problems during the first year after lung transplant. In this context, the most severe form of bronchial stenosis reported in the literature is vanishing bronchus syndrome, which is the obliteration with atresia of the ostium of a lobar bronchus, usually related to ischemia and infection. Ex vivo lung perfusion is a novel strategy for lung allograft preservation that keeps the organs at physiologic protective conditions. Nevertheless, many ex vivo systems work with lungs in supine position, and upper regions (middle lobe and lingula) can have lower perfusion supply, increasing the risk of a relative ischemia. We report a case of vanishing middle bronchus after ex vivo reconditioning bilateral lung transplant in a 45-year-old man with nonspecific interstitial pneumonia, whose posttransplant course was complicated by Aspergillus fumigatus infection.