PURPOSE:Endobronchial stenosis are a significant post lung transplant complication with considerable morbidity and mortality. Experiences in patients with recurrent (two and more) airway stenoses are limited. The purpose of the study is to present a single center perspective.
METHODS:A retrospective single center study of 149 bronchoscopic interventions in eleven lung transplanted patients with recurrent airway stenoses.
RESULTS:In total 149 interventions were performed between 2004 and 2007. In all eleven (4 female and 7 male) patients first intervention was required after 2–4 months. Ballon dilatation was performed 87×, endobronchial stenting 31×, Laser therapy 26×, Kryotherapy 2×, forceps 3×. The most targeted location was the bronchus intermedius (56/87 ballon dilatations and 21/31 stents). Applied energy for laser therapy ranged between 35 and 6220 Joule with endobronchial bleeding formig the mayor complication.Most frequently used stents were AERO-Stents (16×), followed by Ultraflex covered stents (13×), others stents 2×. Two patients received totally six stents successively. Ultraflex stents and AERO stents respectively were placed over a mean period of 84 days (vs 58 d) (maximum of 330d (vs 100d) and minimum of 1 day). One custom-made (ECO) stent with an extra opening for ventilation of the upper lobe was used. No complications were observed, the stent was replaced after 140 days. Other stent-related complications such as granuloma formation and dislocation occurred in Ultraflex and AERO stents with the same frequency. In 3 Ultraflex stents removal was only possible after fragmentation.
CONCLUSION:When recurrent balloon dilatations are not sufficient to treat airway stenoses in lung transplant recipients, temporary stent placement is a treatment alternative. The fully covered Nitinol device AERO and custom-made stents (ECO)add in our experience to the other stenting devices. Repetive stenting (up to 6x) and balloon dilatations (up to 20x) were safe and no anastomotic complications were observed.
CLINICAL IMPLICATIONS:Recurrent airway stenoses are a challenging complication after lung transplantation. The application of new stenting devices enriches the current treament options.
DISCLOSURE:Leif Hanitsch, None.