PURPOSE: To analyze the impact of Bronchial Stenosis (BS) on post transplant pulmonary function.
METHODS: Longitudinal prospective study was performed on patients who underwent Lung transplant [LT] from January 2004 to December 2005. Patients who did not survive the initial transplant hospitalization were excluded.BS is defined as a greater than 20% drop in FEV 1, narrowing at the anastamotic site during bronchoscopy and no other explanation for drop in FEV1.
RESULTS: Over 2 years, 23 out of 34 patients were followed. Mean age of transplanted patients was 51. Thirteen (57%) patients had BS, of which 9 (39%) had stents placed and 4[17%]had endoscopic dilatation(ED) only.Stents were placed in symptomatic patients only with BS and a decline in FEV1 > 20%. Mean days to stent was 142 days. Patients with Pulmonary Fibrosis (IPF) were more prone to anastamotic narrowing (66% of all IPF patients transplanted, p 0.0468) as against other diagnoses. Age, sex, CMV status, reperfusion injury, ventilator days, double vs single LT, ischemic time, infections in the first 3 months and acute rejection did not influence the incidence of BS. The rate of decline of FEV1 in patients who had stent placement was HIGHER compared to patients without AC (p<0.0001). The mean FEV1 in patients with stent was 1.91 as against 2.4 in patients without AC.Four underwent ED only and had a persistent improvement in FEV1 with time (p 0.0009). Two of the 23 patients died, however there was no statistical significance in survival between patients with and without BS.
CONCLUSION: LT patients with AC and a drop in FEV1 requiring stent placement have a more rapid decline in their FEV1 over time as compared to patients without AC.Stents were placed only in symptomatic patients with a decrease in FEV1 which did not alter the progression of graft loss.Early dilatation in asymptomatic patients with BS resulted in persistant improvement in FEV 1.
CLINICAL IMPLICATIONS: Early intervention in asymptomatic patients with BS could change the rate of decrease in FEV1 post LT.
DISCLOSURE: Ramesh Babu Kesavan, No Financial Disclosure Information; No Product/Research Disclosure Information