SUCCESSFUL RESECTION OF OBSTRUCTING AIRWAY GRANULATION-TISSUE FOLLOWING LUNG TRANSPLANTATION USING ENDOBRONCHIAL LASER (ND-YAG) THERAPY

Objective: Airway obstruction due to an excessive growth of granulatio n tissue at the level of the anastomosis is an important complication following lung transplantation which requires early diagnosis and trea tment. We report encouraging experience in the management of this cond ition using endobronchial Nd:YAG laser therapy. Methods: Four adult lu ng transplant recipients developed airway anastomotic obstruction seco ndary to granulation tissue formation at 9, 10, 32 and 32 days followi ng bilateral sequential lung transplantation (2 patients), en bloc dou ble lung transplantation (1 patient) and single lung transplantation ( 1 patient). The diameter of the airways at the level of the anastomose s was reduced by 75, 30, 60, 60, 50 and 90%, respectively. Endobronchi al Nd:YAG laser was applied via a fiberoptic bronchoscope introduced t hrough a rigid bronchoscope. The granulation tissue was visualised and resected with photcoagulation with the laser using between 1000-2000 J depending on the amount of tissue present. Necrotic tissue was remov ed with large forceps. If the obstruction extended to the orifice of a lobar bronchus resection was undertaken in a staged fashion, Results: Airway patency was fully restored at two anastomotic sites! and resto red to 90% patency at two and 80 and 75% at one each. respectively. Th is was associated with a significant improvement in pulmonary function in 3 patients. One patient had a subsequent bougie dilatation of a st enotic area and 2 patients received an endobronchial stent for tracheo or broncho-malacia. One patient died from a gastrointestinal haemorrh age, Three patients are well at 10, 17 and 18 months following transpl antation and have had no further granulation tissue recurrence. There were no complications directly attributable to laser therapy. Conclusi on: Our encouraging early experience lends us to suggest that Endobron chial Nd-YAG laser therapy should be considered in the management of a irway anastomotic obstruction due to excessive granulation tissue form ation after lung transplantation. (C) 1997 Elsevier Science B.V.