Single Lung Transplant Complicated by Anastomotic Pulmonary Artery Stenosis

Abstract

SESSION TITLE: Transplantation SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Anastomotic pulmonary artery stenosis after lung transplantation is a rare complication. Endovascular stenting appears to be a safe and efficacious treatment modality1. CASE PRESENTATION: A 43-year-old female with COPD underwent a single left lung transplant. Four months post-transplant, she presented with progressive hypoxic respiratory failure. CT chest showed a new ill-defined 2.2 x 2.1 cm nodular opacity in the left lower lobe graft shown in Figure 1. Transbronchial biopsy was negative for rejection. Bronchoalveolar lavage showed Aspergillus antigen index of 7.56 and culture grew 1 colony of non-sporulating filamentous fungus. CT-guided biopsy of the lesion showed necrotic lung parenchyma. She was treated empirically with intravenous and inhaled Amphotericin B. Despite treatment, her respiratory failure worsened and she became heated high flow oxygen dependent. Quantitative nuclear lung perfusion scan showed an overall perfusion to the right native lung was calculated to be 77.04% with overall perfusion to the left graft lung calculated to be 22.96%. Right heart angiography confirmed significant stenosis of the left pulmonary artery shown in Figure 2. Placement of a 26 mm x 12 mm LD Mega stent resulted in minimal residual stenosis. Repeated nuclear lung perfusion showed overall perfusion of left graft lung increased to 57.34%. She was eventually discharged home on room air. DISCUSSION: Pulmonary artery stenosis is a rare complication after lung transplantation. It requires a high index of suspicion especially after ruling out rejection and infection etiologies. Open repair carries high mortality and morbidity risk. To date, there have been a few case reports and retrospective studies to support the safety and efficacy of percutaneous endovascular stent placement2. Our patient tolerated the procedure well and had significant clinical improvement. CONCLUSIONS: Percutaneous endovascular stent placement is gaining acceptance as the first choice treatment for pulmonary artery stenosis following lung transplant since it is better tolerated than open repair. It appears to be safe and efficacious. However, long-term outcomes are not clear at this point. Reference #1: Grubstein A et al. Angioplasty using covered stents in five patients with symptomatic pulmonary artery stenosis after single-lung transplantation. Cardiovasc Intervent Radiol, 2014; 37: 686-690. Reference #2: Anaya-Ayala JE et al. Endovascular management of early lung transplant-related anastomotic pulmonary artery stenosis. J Vasc Interv Radiol, 2015; 26: 878-882. DISCLOSURE: The following authors have nothing to disclose: Van Le, Amy Pope-Harman No Product/Research Disclosure Information