Airway complications after lung transplantation: treatment and long-term outcome.
BACKGROUND
Airway complications are a significant cause of morbidity after lung transplantation. Effective treatment reduces the impact of these complications.


METHODS
Data from 123 lung (99 single, 24 bilateral) transplants were reviewed. Potential risk factors for airway complications were analyzed. Stenoses were treated with expanding metal (Gianturco) stents.


RESULTS
Mean follow-up was 749 days. Thirty-five complications developed in 28 recipients (complication rate: 23.8%/anastomosis). Mean time to diagnosis was 47 days. Only Aspergillus infection and airway necrosis were significantly associated with development of complications (p < 0.00001 and p < 0.03, respectively). Stenosis was diagnosed an average of 42 days posttransplant. Average decline in forced expiratory volume in 1 second (FEV1) was 39%. Eighteen patients (13 single and 5 bilateral) required stent insertion. Mean increase in FEV1 poststenting was 87%. Two stent patients died from infectious complications. Six patients required further intervention. Long-term survival and FEV1 did not differ from nonstented patients.


CONCLUSIONS
Aspergillus and airway necrosis are associated with the development of airway complications. Expanding metal stents are an effective long-term treatment.
Department of Radiology, Papworth Hospital, Cambridge, United Kingdom.
J M
JM
Herrera
K D
KD
McNeil
R S
RS
Higgins
R A
RA
Coulden
C D
CD
Flower
S A
SA
Nashef
J
J
Wallwork
D001982:Bronchial Diseases / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome