A retrospective study of silicone stent placement for management of anastomotic airway complications in lung transplant recipients: short- and long-term outcomes.
BACKGROUND
Airway anastomotic complications remain a major cause of morbidity and mortality after lung transplantation (LT). Few data are available with regard to the use of silicone stents for these airway disorders. The aim of this retrospective study was to evaluate the clinical efficacy and safety of silicone stents for such an indication.


METHODS
Data of adult lung transplant recipients who had procedures performed between January 1997 and December 2007 at our institution were reviewed retrospectively. We included patients with post-transplant airway complications who required bronchoscopic intervention with a silicone stent.


RESULTS
In 17 of 117 (14.5%) LT recipients, silicone stents were inserted at a mean time of 165 (range 5 to 360) days after surgery in order to palliate 23 anastomotic airway stenoses. Symptomatic improvement was noted in all patients, and mean forced expiratory volume in 1 second (FEV(1)) increased by 672 +/- 496 ml (p < 0.001) after stent insertion. The stent-related complication rate was 0.13/patient per month. The latter consisted of obstructive granulomas (n = 10), mucus plugging (n = 7) and migration (n = 7), which were of mild to moderate severity and were successfully managed endoscopically. Mean stent duration was 266 days (range 24 to 1,407 days). Successful stent removal was achieved in 16 of 23 cases (69.5%) without recurrence of stenosis. Overall survival was similar in patients with and without airway complications (p = 0.36).


CONCLUSIONS
Silicone stents allow clinical and lung function improvement in patients with LT-related airway complications. Stent-related complications were of mild to moderate severity, and were appropriately managed endoscopically. Permanent resolution of airway stenosis was obtained in most patients, allowing definitive stent removal without recurrence.
Department of Thoracic Endoscopy, Marseille Lung Transplant Group, Université de la Méditerrannée, Assistance Publique-Hôpitaux de Marseille, Marseille, France. herve.dutau@mail.ap-hm.fr
Hervé
H
Dutau
Arnaud
A
Cavailles
Lama
L
Sakr
Monique
M
Badier
Jean-Yves
JY
Gaubert
Stéphanie
S
Boniface
Christophe
C
Doddoli
Pascal
P
Thomas
Martine
M
Reynaud-Gaubert
D000293:Adolescent; D000328:Adult; D001982:Bronchial Diseases / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D020878:Device Removal; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D012828:Silicones; D015607:Stents / Q000009:adverse effects / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D012828:Silicones