PURPOSE: To determine outcome in lung transplant recipients with stenotic airways subjected to balloon dilatation procedures in preparation for stent placement.
METHODS: Retrospective data was collected from the first 125 lung transplant recipients registered in the Mayo Clinic Jacksonville Lung Transplant Database. Data and follow up was determined as of June 7th 2001 to April 27th 2007.
RESULTS: Ninety seven balloon dilations were performed in 18 patients with progressive stenosis of the anastomosis or distal transplanted airways. Idiopathic pulmonary fibrosis (IPF) was strongly associated with the need for balloon dilation (relative risk 4.9). Donor lung ischemia time was 253 ± 111 minutes for patients later requiring balloon dilation (BD+) and 254 ± 89 for those who did not require intervention (BD-) ( p=0.9); donor PaO2 / FiO2 ratio for BD+ was 321 ± 111 and 370 ± 129 for BD- (p=0.12). Episodes of rejection, ischemia reperfusion injury, bacterial or fungal colonization prior to the procedure, donor age, days in intensive care, days in the hospital and days on the ventilator after transplant were similar for BD+ patients compared to BD- cases. Thirteen of the 18 (72%) patients eventually required stent placement. Baseline FEV1 improved from 1.67L ± to 2.31L three months after balloon therapy with or without stent placement (p=0.003). Balloon dilatation therapy was generally well tolerated but one case eventually developed massive and fatal hemorrhage. One year survival for BD+ patients was not significantly different from BD- (88% and 81% respectively, p=0.3).
CONCLUSION: Eighteen of 125 (14%) lung transplant recipients developed stenotic airways requiring balloon dilatation in preparation for stent placement. Five of 18 (28%) achieved sustained dilatation obviating stent insertion. A diagnosis of idiopathic pulmonary fibrosis was strongly associated with large airway complications requiring balloon dilatation. One fatal complication occurred out of 97 dilatation procedures (1%).
CLINICAL IMPLICATIONS: A subgroup of lung transplant recipients with stenotic airways will regain a viable airway lumen with balloon dilatations alone, obviating long term complications derived from stent placement.
DISCLOSURE: David Erasmus, No Financial Disclosure Information; No Product/Research Disclosure Information