Treatment of Complex Airway Lesions After Lung Transplantation With Self-Expandable Nitinol Stents: Early Experience

• Published in: Transplantation proceedings 2010-05, Vol.42 (4), p.1279-1280
• Main Authors: Anile, M, Venuta, F, Diso, D, Liparulo, V, Ricella, C, De Giacomo, T, Pugliese, F, Rolla, M, Quattrucci, S, Pecoraro, Y, Rendina, E.A, Coloni, G.F
• Format: Article
• Language: English
• Subjects: Alloys; Biological and medical sciences; Cystic Fibrosis - etiology; Cystic Fibrosis - surgery; Cystic Fibrosis - therapy; Dilatation - methods; Emphysema - etiology; Emphysema - surgery; Emphysema - therapy; Forced Expiratory Volume; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Lung Transplantation - adverse effects; Medical sciences; Pulmonary Fibrosis - etiology; Pulmonary Fibrosis - surgery; Pulmonary Fibrosis - therapy; Silicones; Stents; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Treatment Outcome
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.03.092

Abstract Airway complications (AC) are considered a serious cause of morbidity after lung transplantation (LT). Mechanical dilatation, laser vaporization, and silicone stent placement usually solve it. However, the use of self-expandable metallic stents (SENS) may be indicated in selected cases. Ten lung transplant recipients with AC were treated with SENS. Six patients underwent LT for cystic fibrosis, 2 for idiopathic pulmonary fibrosis, 1 for bronchiectasis, and 1 for emphysema. All patients received at least 1 treatment attempt with dilatation and silicone stent placement. The indications for SENS placement were the presence of a tortuous airway axis with stenosis and malacia of the right main bronchus in 5 patients; a long stenosis of the main and intermediate right bronchus involving the upper lobe orifice in 3 patients; or malacia that could not be stabilized with silicone stents in 3 cases. In 1 patient the procedure was bilateral. Functional improvement was immediate with a mean forced expiratory volume at 1 second (FEV1 ) gain of 35%. No stent dislocation was observed. Symptoms did not occur again in 5 patients with previous recurrent episodes of pneumonia. One stenosis, which was due to the ingrowth of granulation tissue occurred at 6 months after the procedure, was successfully treated with mechanical dilatation and laser vaporization. The deployment of SENS in a selected group of patients with AC after LT was easy, safe, and effective.