Original clinical science
A retrospective study of silicone stent placement for management of anastomotic airway complications in lung transplant recipients: Short- and long-term outcomes

https://doi.org/10.1016/j.healun.2009.12.011Get rights and content

Background

Airway anastomotic complications remain a major cause of morbidity and mortality after lung transplantation (LT). Few data are available with regard to the use of silicone stents for these airway disorders. The aim of this retrospective study was to evaluate the clinical efficacy and safety of silicone stents for such an indication.

Methods

Data of adult lung transplant recipients who had procedures performed between January 1997 and December 2007 at our institution were reviewed retrospectively. We included patients with post-transplant airway complications who required bronchoscopic intervention with a silicone stent.

Results

In 17 of 117 (14.5%) LT recipients, silicone stents were inserted at a mean time of 165 (range 5 to 360) days after surgery in order to palliate 23 anastomotic airway stenoses. Symptomatic improvement was noted in all patients, and mean forced expiratory volume in 1 second (FEV1) increased by 672 ± 496 ml (p < 0.001) after stent insertion. The stent-related complication rate was 0.13/patient per month. The latter consisted of obstructive granulomas (n = 10), mucus plugging (n = 7) and migration (n = 7), which were of mild to moderate severity and were successfully managed endoscopically. Mean stent duration was 266 days (range 24 to 1,407 days). Successful stent removal was achieved in 16 of 23 cases (69.5%) without recurrence of stenosis. Overall survival was similar in patients with and without airway complications (p = 0.36).

Conclusions

Silicone stents allow clinical and lung function improvement in patients with LT-related airway complications. Stent-related complications were of mild to moderate severity, and were appropriately managed endoscopically. Permanent resolution of airway stenosis was obtained in most patients, allowing definitive stent removal without recurrence.

Section snippets

Study design

Data of adult lung transplant patients performed between January 1997 and December 2007 from our institution were reviewed retrospectively. Patients with LT-related airway complications who required a bronchoscopic intervention using a silicone stent were included in the study. No ethical considerations were raised.

Procedures and clinical follow-up

Donor lung procurement and preservation and the surgical procedure were performed as previously described, according to standard requirements.13, 14 First-line maintenance

Results

Between January 1997 and December 2007, 117 lung transplant procedures (13 single LTs, 101 bilateral sequential LTs and 3 heart–lung transplants), representing a total of 221 bronchial anastomoses, were performed. Post-transplant airway complications were observed in 17 (14.5%) patients (10 males, 7 females), aged 37 ± 15 years (range 18 to 60 years), who underwent 14 bilateral sequential LTs, 2 left single LTs and 1 right single LT (31 bronchial anastomoses). Patient demographics and clinical

Discussion

LT-related airway complications still occur in 5% to 30% of LT recipients.3, 6, 9, 10, 11, 12 We found that 14.5% of patients required endoscopic management and stent placement for these complications. Bronchial ischemia remains the main cause of post-transplant airway complications, but infection has also been identified as a risk factor for anastomotic strictures.15, 16, 17 Among infectious agents, fungal colonization is commonly associated with bronchial complications, and Aspergillus

Disclosure statement

The authors have no conflicts of interest to disclose.

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