Abstract
Objectives: To determine if mycophenolate mofetil reduces the incidence and severity of granulation tissue in-growth in canine tracheal stent patients.Study design: Randomized clinical trial.Animals: 111 dogs from the hospital population.Methods: Client-owned dogs that received an endoluminal self-expanding tracheal stent for canine tracheal collapse between 2014 and 2020 were randomly assigned into one of two treatment groups. Control group medication protocol consisted of prednisone 0.5 mg/kg PO BID/SID/EOD × 30 days, hydrocodone 0.25 mg/kg PO TID × 30 days, and cefovecin 8 mg/kg SQ post-placement. Mycophenolate group medication protocol was identical to the control group medication protocol with the addition of mycophenolate mofetil 10 mg/kg PO BID × 30 days, SID for life. Recheck tracheoscopy was performed at 1, 3, and 6 months post-stent placement. Presence and severity of granulation tissue were determined by tracheoscopy and were recorded as a percentage of tracheal lumen obstruction by blinded evaluators (none present, <25%, >25–50%, and >50%).Results: At none of the three time points was there a statistically significant difference in grade between controls and those receiving mycophenolate (p = 0.467, p = 0.330, and p = 0.410).Conclusions and Clinical Significance: Our results suggest that mycophenolate can be safely given to these patients but do not support that its administration will reduce the incidence and severity of granulation tissue. Although a difference was observed in the severity of granulation tissue between the two groups, loss to follow-up may have influenced conclusions. A larger study would be warranted to further evaluate the effect of mycophenolate on the development of granulation tissue.
Highlights
Canine tracheal collapse syndrome is a progressive condition characterized by the degeneration of tracheal cartilage rings, leading to life-threatening dynamic airway collapse in the most severe of cases, with no curative treatment available [1]
Dogs diagnosed with tracheal collapse between June 2014 and June 2020 by utilizing thoracic radiographs and tracheoscopy followed by tracheal stent placement under fluoroscopy were included in this prospective study
Mycophenolate group medication protocol was identical to the control group medication protocol with the addition of mycophenolate mofetil 10 mg/kg PO BID
Summary
Canine tracheal collapse syndrome is a progressive condition characterized by the degeneration of tracheal cartilage rings, leading to life-threatening dynamic airway collapse in the most severe of cases, with no curative treatment available [1]. The most common procedures reported for the management of tracheal collapse include the use of extraluminal ring prosthesis and intraluminal stent placement [1]. Intraluminal tracheal stent placement is a minimally invasive procedure with rapid post-operative improvement in most cases [4]. Post-operative complications reported include stent fracture, granulation tissue in-growth within the tracheal lumen, pneumonia, tracheal infection, progressive tracheal collapse, and stent migration or shortening [5]. Granulation tissue ingrowth is a common complication reported in 28 to 49% of dogs [1, 5]. This inflammatory tissue leads to loss of tracheal lumen aperture and may progress to a life-threatening reduction in air flow
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