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The Use of Endoscopic Argon Plasma Coagulation in Airway Complications After Solid Organ Transplantation*

Cesar A. Keller, MD; Rachel Hinerman, MD; Ashish Singh, MD; Francisco Alvarez, MD
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*From the Division of Pulmonary, Critical Care, and Occupational Medicine, St. Louis University Hospital, St. Louis, MO.

Correspondence to: Cesar Keller, MD, Division of Pulmonary, Critical Care, and Occupational Medicine, St. Louis University, 7 FDT, St. Louis University Hospital, 3635 Vista at Grand Blvd, St. Louis, MO 63110



Chest. 2001;119(6):1968-1975. doi:10.1378/chest.119.6.1968
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The objective of the study was to describe a safe and effective treatment option for endobronchial complications after solid organ transplantation. A retrospective analysis was performed in a tertiary-care university hospital. The use of bronchoscopic argon plasma coagulation (APC) for the treatment of endobronchial lesions was studied in five solid organ transplant recipients. Four patients presented with variable degrees of endobronchial obstruction, and one patient presented with massive hemoptysis. Two of the patients with endobronchial obstruction were double lung transplant recipients who developed anastomotic strictures. The strictures were opened with endobronchial stents but became obstructed again by inflammatory granulation tissue overgrowth through the stent mesh. APC was used to maintain airway patency. One kidney transplant recipient developed pulmonary zygomycosis with secondary obstruction of the left main bronchus because of granulation tissue growth through endobronchial stents. Airway patency was reestablished with several treatments with APC. Another kidney transplant recipient developed subglottic and tracheal papillomatosis that was effectively removed with APC. A heart transplant recipient was referred with recurrent massive hemoptysis refractory to bronchial artery embolization. The bleeding was caused by hemorrhagic polypoid lesions, which were completely ablated by APC. Bronchoscopic use of the argon plasma coagulator is a safe and simple technique that can be used effectively to treat endobronchial pathology in solid organ transplant patients.

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