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

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.