Study objectives: To assess the efficacy and
complications of different interventional bronchoscopic techniques used
to treat airway complications after lung transplantation.
Design: Retrospective study.
Heart-lung transplant unit of a university hospital.
Patients: From November 1986 to January 2000,
interventional bronchoscopy was performed in 41 of 312 lung transplant
recipients (13.1%) for tracheobronchial stenosis, bronchomalacia,
granuloma formation, and dehiscence.
Dilatation, stent placement, laser or forceps excision.
Measurements and results: Mean (± SE) improvement in
FEV1 in 26 patients undergoing dilatation for a stenotic or
a combined lesion was 93 ± 334 mL or 8 ± 21%. In seven of these
patients not proceeding to stent placement, mean improvement in
FEV1 was 361 ± 179 mL or 21 ± 9%. Patients needing
stent placement after dilatation had a mean change in FEV1
after dilatation of − 5 ± 325 mL or 3 ± 23%, and an
improvement of 625 ± 480 mL or 52 ± 43% after stent insertion.
Mean improvement in FEV1 for patients treated with stent
insertion for bronchomalacia was 673 ± 30 mL or 81 ± 24%.
Complications of airway stents were migration (27%), mucous plugging
(27%), granuloma formation (36%), stent fracture (3%), and formation
of a false passage (6%). Mortality associated with interventional
bronchoscopy was 2.4% (1 of 41 patients). For patients with airway
complications successfully undergoing interventional bronchoscopy, the
overall 1-year, 3-year, and 5-year survival rates were 79%, 45%, and
32%, respectively, vs 87%, 69%, and 56% for those without airway
complications (p < 0.05).
Conclusion: Only a small
number of patients with airway stenosis after lung transplantation will
respond to bronchial dilatation alone. Patients with airway
complications after lung transplantation have a higher mortality than
patients without airway complications.