Bronchial and vascular anastomotic complications usually occur within a week of lung transplantation, with patients demonstrating increased dyspnea, pulmonary arterial hypertension, and hypoxia. Ischemic injury leading to obstruction with narrowing of the anastomosis is the most common cause, and usually results from surgical interruption of bronchial blood supply and innervation, suboptimal anastomosis formation, rejection, infection that is usually fungal (Aspergillus and Candida), less often bacterial infection (Pseudomonas, other gram-negative bacilli, and coagulase-positive staphylococci), poor healing, and airway dehiscence.