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Interventional bronchoscopy for the management of airway complications following lung transplantation.

AbstractSTUDY OBJECTIVES:
To assess the efficacy and complications of different interventional bronchoscopic techniques used to treat airway complications after lung transplantation.
DESIGN:
Retrospective study.
SETTING:
Heart-lung transplant unit of a university hospital.
PATIENTS:
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.
INTERVENTIONS:
Dilatation, stent placement, laser or forceps excision.
MEASUREMENTS AND 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).
CONCLUSION:
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.
AuthorsP N Chhajed, M A Malouf, M Tamm, P Spratt, A R Glanville
JournalChest (Chest) Vol. 120 Issue 6 Pg. 1894-9 (Dec 2001) ISSN: 0012-3692 [Print] United States
PMID11742919 (Publication Type: Journal Article)
Topics
  • Adolescent
  • Adult
  • Bronchial Diseases (etiology, mortality, therapy)
  • Bronchoscopy
  • Cause of Death
  • Child
  • Dilatation
  • Female
  • Granuloma (etiology, mortality, therapy)
  • Humans
  • Laser Therapy
  • Lung Transplantation
  • Male
  • Middle Aged
  • Postoperative Complications (etiology, mortality, therapy)
  • Prosthesis Failure
  • Retreatment
  • Stents
  • Surgical Wound Dehiscence (etiology, mortality, therapy)
  • Survival Rate
  • Tracheal Stenosis (etiology, mortality, therapy)

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