title: Stents for bronchial stenosis after lung transplantation: should they be removed?
abstract: BACKGROUND
  Airway complications after lung transplantation are the major cause of morbidity, affecting up to 33% of all cases. Bronchial stenosis is the most common complication. The use of stents has been established as the most effective therapy; however, their removal is recommended after 3-6 months of use. We have been using self-expandable stents as a definitive treatment and remove them only if necessary. For this report, we evaluated the use of self-expandable stents as a definitive treatment for bronchial stenosis after lung transplantation.
  
  
  METHODS
  We performed a retrospective cohort study to evaluate patients with bronchial stenosis from August 2003 to April 2014. Clinical and pulmonary function test data were collected.
  
  
  RESULTS
  Two hundred lung transplants were performed, 156 of which were bilateral. Sixteen patients experienced airway complications: 4 had dehiscence, 2 necrosis, and 10 bronchial stenosis. Of these patients, 7 had undergone bilateral procedures, and 2 patients developed stenosis in both sides. Twelve anastomotic stenoses were observed. The follow-up after stenting ranged from 1 to 7 years. All patients had increased lung function, and 4 remained stable with sustained increase in pulmonary function without episodes of infection. Three patients required removal of their prosthesis 6 months to 1 year after implantation because of complications. Two patients died owing to unrelated causes.
  
  
  CONCLUSIONS
  Definitive treatment of bronchial stenosis with self-expandable stents is a viable option. The 1st year seems to be the most crucial for determining definitive treatment, because no patients required removal of their stent after 1 year.
authors.affiliation: Thoracic Surgery Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: H V S
authors.initials: HV
authors.lastname: Fonseca
authors.affiliation: Thoracic Surgery Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: H V S
authors.initials: HV
authors.lastname: Fonesca
authors.affiliation: Thoracic Surgery Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: L R
authors.initials: LR
authors.lastname: Iuamoto
authors.affiliation: Thoracic Surgery Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: H
authors.initials: H
authors.lastname: Minamoto
authors.affiliation: Thoracic Surgery Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: L G
authors.initials: LG
authors.lastname: Abdalla
authors.affiliation: Thoracic Surgery Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: L M
authors.initials: LM
authors.lastname: Fernandes
authors.affiliation: Thoracic Surgery Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: P C L
authors.initials: PC
authors.lastname: Camargo
authors.affiliation: Thoracic Surgery Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. Electronic address: marcos.samano@incor.usp.br.
authors.forename: M N
authors.initials: MN
authors.lastname: Samano
authors.affiliation: Thoracic Surgery Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: P M
authors.initials: PM
authors.lastname: Pêgo-Fernandes
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D001982:Bronchial Diseases / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D003251:Constriction, Pathologic / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D003657:Decision Making; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents; D055815:Young Adult