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Vol. 47. Issue 3.
Pages 128-133 (January 2011)
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Vol. 47. Issue 3.
Pages 128-133 (January 2011)
Original Article
DOI: 10.1016/S1579-2129(11)70031-3
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Treatment of Airway Complications Following Lung Transplantation
Tratamiento de complicaciones en la vía aérea postrasplante pulmonar
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Sebastián Fernández-Bussya,b,??
Corresponding author
bussysf@medicine.ufl.edu

Corresponding author.
, Adnan Majidc, Iván Caviedesb, Olufemi Akindipea, Maher Baza, Michael Jantza
a División de Neumología Intervencional, Shands at University of Florida, Gainesville, USA
b División de Neumología Intervencional, Clínica Alemana de Santiago, Chile
c División de Neumología Intervencional, Beth Israel Deaconess Medical Center, Boston, USA
Article information
Abstract
Objective

To describe our experience in airway complications following lung transplantation and to suggest a management strategy using different interventional bronchoscopic techniques.

Method

Retrospective analysis of all airway complications following lung transplantation from January 1999 to July 2007.

Results

During this period, 223 patients underwent lung transplantation, with a total of 345 airway anastomoses. In 70 (20.23%), there were complications requiring endoscopic intervention. A total of 631 procedures were carried out in 52 patients. Thirty-three patients presented a combination of bronchial stenosis and bronchomalacia, 18 patients had bronchial stenosis alone and 1 patient presented dehiscence of the anastomosis. In most cases, pneumatic balloon dilatation was effective, although temporarily, and ultimately 47 patients required endobronchial stent placement. The most common complication associated with the use of stents was granulation tissue formation, seen in 57.3% of patients. After stent placement, forced expiratory volume in one second (FEV1) improved significantly.

Conclusion

Airway complications after lung transplantation are frequent. Balloon dilatation was effective in only a few patients with bronchial stenosis, requiring stent placement in most. Airway permeabilization after endobronchial stent placement improved FEV1 in these patients. Based on our experience, we propose a management strategy for airway complications after lung transplantation.

Keywords:
Bronchoscopy
Stent
Stenosis
Bronchomalacia
Lung transplantation
Airway complications
Dehiscence
Balloon dilatation
Argon plasma coagulation
Resumen
Propósito

Describir nuestra experiencia en las complicaciones de la vía aérea después del trasplante pulmonar y sugerir un esquema de tratamiento, utilizando diferentes técnicas de broncoscopia intervencionista.

Método

Análisis retrospectivo de todas las complicaciones en la vía aérea postrasplante pulmonar desde enero de 1999 hasta julio de 2007.

Resultados

Durante este periodo, en 223 pacientes se realizó trasplante pulmonar, un total de 345 anastomosis en la vía aérea. En 70 de ellas (20,23%) hubo complicaciones, requiriendo de intervención endoscópica. Se realizó un total de 631 procedimientos en 52 pacientes. Treinta y tres pacientes presentaron la combinación de estenosis bronquial con broncomalacia, 18 pacientes presentaron solo estenosis bronquial y 1 paciente presentó dehiscencia de la anastomosis. En la mayoría de los casos, la dilatación neumática por balón tuvo efectividad transitoria, 47 pacientes requirieron de la instalación de un stent endobronquial. La complicación más común asociada con la utilización de stents fue el tejido de granulación en el 57,3% de los pacientes. Luego de la colocación de stents, el volumen espiratorio forzado en el primer segundo (FEV1) mejoró significativamente.

Conclusiones

Las complicaciones de la vía aérea después del trasplante pulmonar son frecuentes. En pocos pacientes con estenosis de la vía aérea hubo resolución definitiva con dilatación bronquial neumática, requiriendo la mayoría de la colocación de stents endobronquiales. La permeabilización de la vía aérea por stents endobronquiales demostró mejorar el FEV1 en estos pacientes. Sobre nuestra experiencia, proponemos un esquema de manejo de las complicaciones de la vía aérea postrasplante pulmonar.

Palabras clave:
Broncoscopia
Stent
Estenosis
Broncomalacia
Trasplante de pulmón
Complicaciones de la vía aérea
Dehiscencia
Dilatación neumática
Coagulación con Argón plasma
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Copyright © 2011. Sociedad Española de Neumología y Cirugía Torácica
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Archivos de Bronconeumología (English Edition)

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