Transplantation |

Addition of Rapamycin to the Immunosuppressant Regimen Improves Airway Patency in Lung Transplant Patients With Refractory Bronchial Stenosis FREE TO VIEW

Irina Timofte, MD; Maria Crespo, MD; Christian Bermudez, MD; Jonathan D'Cunha, MD; Jay Bhama, MD; Norihisa Shigemura, MD; Bruce Johnson, MD
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UPMC, Pittsburgh, PA

Chest. 2013;144(4_MeetingAbstracts):1014A. doi:10.1378/chest.1703797
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SESSION TITLE: Lung Transplantation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Airway complications such as bronchial stenosis can be a significant cause of morbidity and mortality after lung transplantation. These patients often require multiple interventional bronchoscopic procedures. Since sirolimus has well recognized antiproliferative and immunosuppressive properties, we hypothesized that adding rapamycin to the immunosuppressant regimen of lung transplant recipients who required multiple bronchoscopic intervention for bronchial stenosis would facilitate achieving and maintaining airway patency.

METHODS: We retrospectively reviewed the charts of all lung transplant patients who were started on rapamycin after development of severe bronchial stenosis that required multiple consecutive interventions including balloon bronchoplasty, laser photoresection, endobronchial brachytherapy, and bronchial stents placement.

RESULTS: A total of 10 patients who underwent single or double lung transplantation from 2000 to 2012 were included. All patient had severe airway occlusion (80-100% reduction in cross sectional area) requiring multiple interventional bronchoscopic procedures prior to initiating rapamycin. After adding rapamycin, 8 of 10 patients achieved airway patency within 3 months and 7 of 10 had a significant response in the first month. Additionally, 5 of 7 patients who continued Rapa as part of their immunosuppressive regiment for more than 6 month did not require other subsequent interventional bronchoscopic procedures.

CONCLUSIONS: Airway complications have been mainly attributed to ischemia of the donor bronchus during the immediate post-transplant period. Primary graft dysfunction and especially grade 3-4 ischemia-reperfusion injury( Herrera clasification) is the main risk factors for airway complications. Rapamycin represents a promising option for lung transplant patients with severe airway stenosis.

CLINICAL IMPLICATIONS: The presence of severe persistent IRI should prompt starting Rapamycin early in the first 4-6 month after transplant.

DISCLOSURE: The following authors have nothing to disclose: Irina Timofte, Maria Crespo, Christian Bermudez, Jonathan D'Cunha, Jay Bhama, Norihisa Shigemura, Bruce Johnson

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