Interventional bronchoscopy for the management of airway complications following lung transplantation

Abstract

Study objectives: To assess the efficacy and complications of different interventional bronchoscopic techniques used to treat airway complications after lung transplantation. Design: Retrospective study. Setting: Heart-lung transplant unit of a university hospital. Patients: From November 1986 to January 2000, interventional bronchoscopy was performed in 41 of 312 lung transplant recipients (13.1%) for tracheobronchial stenosis, bronchomalacia, granuloma formation, and dehiscence. Interventions: Dilatation, stent placement, laser or forceps excision. Measurements and results: Mean ( SE) improvement in FEV1 in 26 patients undergoing dilatation for a stenotic or a combined lesion was 93 334 mL or 8 21%. In seven of these patients not proceeding to stent placement, mean improvement in FEV1 was 361 179 mL or 21 9%. Patients needing stent placement after dilatation had a mean change in FEV1 after dilatation of 5 325 mL or 3 23%, and an improvement of 625 480 mL or 52 43% after stent insertion. Mean improvement in FEV1 for patients treated with stent insertion for bronchomalacia was 673 30 mL or 81 24%. Complications of airway stents were migration (27%), mucous plugging (27%), granuloma formation (36%), stent fracture (3%), and formation of a false passage (6%). Mortality associated with interventional bronchoscopy was 2.4% (1 of 41 patients). For patients with airway complications successfully undergoing interventional bronchoscopy, the overall 1-year, 3-year, and 5-year survival rates were 79%, 45%, and 32%, respectively, vs 87%, 69%, and 56% for those without airway complications (p < 0.05). Conclusion: Only a small number of patients with airway stenosis after lung transplantation will respond to bronchial dilatation alone. Patients with airway complications after lung transplantation have a higher mortality than patients without airway complications. (CHEST 2001; 120:1894 –1899)