title: Are metallic stents really safe? A long-term analysis in lung transplant recipients.
abstract: Airway complications affect 20% of all lung transplant recipients. Self-expandable metallic stents (SEMS) are one treatment option but their use in benign airway disorders is controversial. We studies the long-term safety of SEMS in lung transplant recipients. Between January 1998 and February 2008, all lung transplant recipients with SEMS were analysed retrospectively at a single centre. Complications were recorded until September 2008. In 65 (9.2%) out of 706 recipients, 111 (91% noncovered) bronchial SEMS were implanted a median (range) 133 (55-903) days after lung transplantation; follow-up was 777 (7-3.655) days. Clinical improvement was noted in 80% of recipients. The forced expiratory volume in 1 s increased by (mean+/-SD) 21+/-33%. Most frequent early complications were migration (3%) and mucus plugging (11%). No procedure-related deaths were noted. Re-stenosis occurred in 34 (52%) out of 65 recipients 85 (7-629) days after insertion. In multivariate analysis, stent insertion before post-operative day 90 was independently associated with an increased risk of re-stenosis (HR 3.29, 95% CI 1.50-7.18; p = 0.003). In 40% of recipients, new bacterial airway colonisation occurred after SEMS insertion. In SEMS patients, 5-yr survival was significantly lower than in the total cohort (60% versus 76%; p = 0.02). Late complications in lung transplant recipients treated with SEMS are frequent. The major problems are re-stenosis and airway colonisation.
authors.affiliation: Depts of Pulmonary Medicine, Hanover Medical School, Hanover, Germany. gottlieb.jens@mh-hannover.de
authors.forename: J
authors.initials: J
authors.lastname: Gottlieb
authors.forename: T
authors.initials: T
authors.lastname: Fuehner
authors.forename: M
authors.initials: M
authors.lastname: Dierich
authors.forename: O
authors.initials: O
authors.lastname: Wiesner
authors.forename: A R
authors.initials: AR
authors.lastname: Simon
authors.forename: T
authors.initials: T
authors.lastname: Welte
mesh_terms: D000293:Adolescent; D000328:Adult; D001980:Bronchi / Q000382:microbiology; D001982:Bronchial Diseases / Q000209:etiology; D001999:Bronchoscopy / Q000379:methods; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D015999:Multivariate Analysis; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D014135:Tracheal Stenosis / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D008670:Metals