title: Interventional bronchoscopy for the management of airway complications following lung transplantation.
abstract: 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.
authors.affiliation: Heart Lung Transplant Unit, St. Vincent's Hospital, Sydney, Australia. chhajed@hotmail.com
authors.forename: P N
authors.initials: PN
authors.lastname: Chhajed
authors.forename: M A
authors.initials: MA
authors.lastname: Malouf
authors.forename: M
authors.initials: M
authors.lastname: Tamm
authors.forename: P
authors.initials: P
authors.lastname: Spratt
authors.forename: A R
authors.initials: AR
authors.lastname: Glanville
mesh_terms: 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