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Clinical Investigations: TRANSPLANTATION |

Interventional Bronchoscopy for the Management of Airway Complications Following Lung Transplantation*

Prashant N. Chhajed, MD, DNB, FCCP; Monique A. Malouf, FRACP; Michael Tamm, MD; Phillip Spratt, FRACS; Allan R. Glanville, MD, FRACP
Author and Funding Information

*From the Heart Lung Transplant Unit, St. Vincent’s Hospital, Sydney, Australia.

Correspondence to: Prashant N. Chhajed, MD, DNB, FCCP, Heart Lung Transplant Unit, St. Vincent’s Hospital, deLacy Building, Level 14, Victoria St, Darlinghurst, NSW 2010, Sydney, Australia; e-mail: chhajed@hotmail.com



Chest. 2001;120(6):1894-1899. doi:10.1378/chest.120.6.1894
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Study objectives: To assess the efficacy and complications of different interventional bronchoscopic techniques used to treat airway complications after lung transplantation.

Design: Retrospective study.

Setting: 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.

Interventions: 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.

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