Airway Complications and Endoscopic Management After Lung Transplantation

Abstract

Airway complications following lung transplantation are common and difficult to manage. While a bulk of literature exists regarding the prevalence and risk factors associated development of airway complications following lung transplantation, literature guiding specific treatment options is limited. Balloon dilation alone is able to transiently relieve airway stenosis and improve symptoms though it is frequently insufficient. Treatment with airway stenting in severe disease has resulted in significant clinical improvement and can generally be removed with sustained effects. Translational studies into hypoxia-induced gene expression and the lung microbiome offer potential therapeutic targets for improved outcomes moving forward. Balloon dilation for airway stenosis should be considered first-line therapy, with consideration of ablative and topical airway therapy for more effective and sustained results. In severe cases, including dehiscence, malacia, and stenosis, stenting is often required. Silicone and covered metal stents, while sometimes necessary, are not a perfect solution and are associated with their own list of potential complications. In the absence of a robust evidence base, recognition of endoscopic airway phenotypes and the utility of the various bronchoscopic modalities available are essential for treating this complex group of patients.