Interventional bronchoscopy for the management of airway complications following lung transplantation.
OBJECTIVE
To assess the efficacy and complications of different interventional bronchoscopic techniques used to treat airway complications after lung transplantation.


METHODS
Retrospective study.


METHODS
Heart-lung transplant unit of a university hospital.


METHODS
From November 1986 to January 2000, interventional bronchoscopy was performed in 41 of 312 lung transplant recipients (13.1%) for tracheobronchial stenosis, bronchomalacia, granuloma formation, and dehiscence.


METHODS
Dilatation, stent placement, laser or forceps excision.


RESULTS
Mean (+/- SE) improvement in FEV(1) in 26 patients undergoing dilatation for a stenotic or a combined lesion was 93 +/- 334 mL or 8 +/- 21%. In seven of these patients not proceeding to stent placement, mean improvement in FEV(1) was 361 +/- 179 mL or 21 +/- 9%. Patients needing stent placement after dilatation had a mean change in FEV(1) after dilatation of - 5 +/- 325 mL or 3 +/- 23%, and an improvement of 625 +/- 480 mL or 52 +/- 43% after stent insertion. Mean improvement in FEV(1) for patients treated with stent insertion for bronchomalacia was 673 +/- 30 mL or 81 +/- 24%. Complications of airway stents were migration (27%), mucous plugging (27%), granuloma formation (36%), stent fracture (3%), and formation of a false passage (6%). Mortality associated with interventional bronchoscopy was 2.4% (1 of 41 patients). For patients with airway complications successfully undergoing interventional bronchoscopy, the overall 1-year, 3-year, and 5-year survival rates were 79%, 45%, and 32%, respectively, vs 87%, 69%, and 56% for those without airway complications (p < 0.05).


CONCLUSIONS
Only a small number of patients with airway stenosis after lung transplantation will respond to bronchial dilatation alone. Patients with airway complications after lung transplantation have a higher mortality than patients without airway complications.
Chhajed
P N
PN
Heart Lung Transplant Unit, St. Vincent's Hospital, Sydney, Australia. chhajed@hotmail.com
Malouf
M A
MA
Tamm
M
M
Spratt
P
P
Glanville
A R
AR
D000293:Adolescent; D000328:Adult; D001982:Bronchial Diseases / Q000209:etiology / Q000401:mortality / Q000628:therapy; D001999:Bronchoscopy; D002423:Cause of Death; D002648:Child; D004106:Dilatation; D005260:Female; D006099:Granuloma / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D053685:Laser Therapy; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D011475:Prosthesis Failure; D019233:Retreatment; D015607:Stents; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D014135:Tracheal Stenosis / Q000209:etiology / Q000401:mortality / Q000628:therapy