Novel biodegradable stents in the treatment of bronchial stenosis after lung transplantation☆☆☆

Abstract

To evaluate the safety and effectiveness of novel biodegradable (BD) stents to treat bronchial anastomotic stenosis in patients after lung transplantation. Twenty BD stents were implanted endoscopically in six patients (median age 41.5 years (range 35-57 years)) with post-transplant bronchial anastomotic stenoses, between 2006 and 2010. All stents were custom-made from bio-absorbable polydioxanone (PDS). The median stent diameter was 12 mm (8-17 mm) and median length was 20mm (12-30 mm). All patients were evaluated clinically, by bronchoscopy and high-definition computed tomography (CT). The stenosis was initially relieved in all cases. There was no bleeding, perforation or displacement after BD stent implantation. Four patients needed multiple stenting for anastomotic re-stenosis. Median time to any re-stenting was 5 months (2-15 months). There was one sudden death, 1 year after the last BD stent implantation, from a pulmonary embolus. All five survivors are in good clinical condition up to 4 years' follow-up (median 40 months, range 7-48 months) since first stenting and intervention-free up to 44 months (median 24 months, range 7-44 months). This small pilot study shows that BD stents are a safe, effective and reliable alternative to classical metallic stents in patients with anastomotic stenosis after lung transplantation, and may avoid the need for permanent stenting.