Post-transplant bronchial stenosis may cause significant morbidity and mortality. We examined the outcome of transplant patients in which a silicone Y-stent, traditionally employed at the main carina, was placed in a secondary carina for relief of anastamotic and post-anastamotic transplant-related airway stenosis.
A retrospective analysis was performed of all lung transplant patients at the Hospital of the University of Pennsylvania treated with a silicone Y-stent in a secondary carina between January 2008 and April 2009. Stent efficacy was evaluated regarding feasibility of placement and number of procedures required for durable patient results.
Four patients were treated with a Y-stent in the secondary carina due to bronchial stenosis following lung transplant. Three had a stent in the right secondary carina and one in the left secondary carina. On the right, stents were placed with the bifurcation leading to the right upper lobe and bronchus intermedius, or into the right middle and lower lobar bronchi. The mean number of bronchoscopic procedures required for management of bronchial stenosis prior to Y-stent insertion was 14.5 procedures. These procedures included electrocautery, balloon bronchoplasty and traditional stent placement. The mean number of days between procedures was 17.5 days. In up to six-month follow-up after Y-stent placement, the number of procedures was 2.3 bronchoscopic procedures. The mean number of days between procedures after Y stent placement was 95.2 days. There were no complications related to Y-stent insertion although two of the four patients required additional procedures for satisfactory stent results. Granulation tissue developed distally in both patients prior to replacement. All patients had improvement of their spirometry and reported significant subjective improvement of their respiratory status following Y-stent placement.
Silicone Y-stents placed in secondary carina are technically feasible for post-transplant bronchial stenosis. Following this novel stent application, the treated patients had an improved clinical course.
Silicone Y-stent placement in a secondary carina may be the best approach for distal anastamotic or post-anastamotic stenosis. A prospective multicenter study is needed.
Jonathan Puchalski, No Financial Disclosure Information; No Product/Research Disclosure Information