A retrospective study of silicone stent placement for management of anastomotic airway complications in lung transplant recipients: Short- and long-term outcomes

Dutau, Hervé; Cavailles, Arnaud; Sakr, Lama; Badier, Monique; Gaubert, Jean-Yves; Boniface, Stéphanie; Doddoli, Christophe; Thomas, Pascal; Reynaud-Gaubert, Martine

doi:10.1016/j.healun.2009.12.011

« Previous Next »The Journal of Heart and Lung Transplantation
Volume 29, Issue 6 , Pages 658-664, June 2010

A retrospective study of silicone stent placement for management of anastomotic airway complications in lung transplant recipients: Short- and long-term outcomes

Hervé Dutau, MD
- Department of Thoracic Endoscopy, Marseille Lung Transplant Group, Université de la Méditerrannée, Assistance Publique-Hôpitaux de Marseille, Marseille, France
- Reprint requests: Hervé Dutau, MD, Thoracic Endoscopy Unit, Hôpital Sainte-Marguerite, 270 Boulevard de Sainte-Marguerite, Cedex 09, 13274 Marseille, France. Telephone: 33-491-74-46-94. Fax: 33-491-74-54-24
Arnaud Cavailles, MD
- Department of Thoracic Endoscopy, Marseille Lung Transplant Group, Université de la Méditerrannée, Assistance Publique-Hôpitaux de Marseille, Marseille, France
Lama Sakr, MD
- Department of Thoracic Endoscopy, Marseille Lung Transplant Group, Université de la Méditerrannée, Assistance Publique-Hôpitaux de Marseille, Marseille, France
Monique Badier, MD, PhD
- Department of Clinical Physiology, Marseille Lung Transplant Group, Université de la Méditerrannée, Assistance Publique-Hôpitaux de Marseille, Marseille, France
Jean-Yves Gaubert, MD
- Department of Radiology, Marseille Lung Transplant Group, Université de la Méditerrannée, Assistance Publique-Hôpitaux de Marseille, Marseille, France
- Department of Respiratory Medicine, Marseille Lung Transplant Group, Université de la Méditerrannée, Assistance Publique-Hôpitaux de Marseille, Marseille, France
Stéphanie Boniface, MD
- Department of Respiratory Medicine, Marseille Lung Transplant Group, Université de la Méditerrannée, Assistance Publique-Hôpitaux de Marseille, Marseille, France
Christophe Doddoli, MD
- Department of Thoracic Surgery, Marseille Lung Transplant Group, Université de la Méditerrannée, Assistance Publique-Hôpitaux de Marseille, Marseille, France
Pascal Thomas, MD
- Department of Thoracic Surgery, Marseille Lung Transplant Group, Université de la Méditerrannée, Assistance Publique-Hôpitaux de Marseille, Marseille, France
Martine Reynaud-Gaubert, MD, PhD
- Department of Thoracic Surgery, Marseille Lung Transplant Group, Université de la Méditerrannée, Assistance Publique-Hôpitaux de Marseille, Marseille, France

published online 05 February 2010.

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 (FEV₁) 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.

Keywords: lung transplantation, airway stenting, bronchial stenting, bronchial stenosis, anastomotic complications, silicone stents, self-expandable metallic stents