title: Successful resection of obstructing airway granulation tissue following lung transplantation using endobronchial laser (Nd:YAG) therapy.
abstract: OBJECTIVE
  Airway obstruction due to an excessive growth of granulation tissue at the level of the anastomosis is an important complication following lung transplantation which requires early diagnosis and treatment. We report encouraging experience in the management of this condition using endobronchial Nd:YAG laser therapy.
  
  
  METHODS
  Four adult lung transplant recipients developed airway anastomotic obstruction secondary to granulation tissue formation at 9, 10, 32 and 32 days following bilateral sequential lung transplantation (2 patients), en bloc double lung transplantation (1 patient) and single lung transplantation (1 patient). The diameter of the airways at the level of the anastomoses was reduced by 75, 30, 60, 60, 50 and 90%, respectively. Endobronchial Nd:YAG laser was applied via a fiberoptic bronchoscope introduced through a rigid bronchoscope. The granulation tissue was visualised and resected with photocoagulation with the laser using between 1000-2000 J depending on the amount of tissue present. Necrotic tissue was removed with large forceps. If the obstruction extended to the orifice of a lobar bronchus resection was undertaken in a staged fashion.
  
  
  RESULTS
  Airway patency was fully restored at two anastomotic sites, and restored to 90% patency at two and 80 and 75% at one each, respectively. This was associated with a significant improvement in pulmonary function in 3 patients. One patient had a subsequent bougie dilatation of a stenotic area and 2 patients received an endobronchial stent for tracheo or broncho-malacia. One patient died from a gastrointestinal haemorrhage. Three patients are well at 10, 17 and 18 months following transplantation and have no further granulation tissue recurrence. There were no complications directly attributable to laser therapy.
  
  
  CONCLUSIONS
  Our encouraging early experience leads us to suggest that Endobronchial Nd-YAG laser therapy should be considered in the management of airway anastomotic obstruction due to excessive granulation tissue formation after lung transplantation.
authors.affiliation: Cardiothoracic Unit, St. George's Hospital, London, UK.
authors.forename: B P
authors.initials: BP
authors.lastname: Madden
authors.forename: P
authors.initials: P
authors.lastname: Kumar
authors.forename: R
authors.initials: R
authors.lastname: Sayer
authors.forename: A
authors.initials: A
authors.lastname: Murday
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006097:Granulation Tissue / Q000601:surgery*; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D016040:Lung Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate; D012008:Recurrence; D013997:Time Factors; D014797:Vital Capacity