THE ROLE OF CRYOTHERAPY FOR AIRWAY COMPLICATIONS AFTER LUNG AND HEART-LUNG TRANSPLANTATION

Objective: Although airway problems after lung and heart-lung transpla ntation have been greatly reduced due to changes in surgical technique , excessive granulation tissue at the anastomosis may threaten airway patency. Treatment options include electrocautery, dilation, laser coa gulation and stent placement however, recurrence remains a problem. Cr yotherapy, the controlled application of extreme cold, is effective at causing cell lysis in granulation tissue and may therefore be effecti ve after lung transplantation for airway problems arising from granula tion stenosis. Our objective was to review our experience with cryothe rapy as a first-line treatment for airways compromised by granulation tissue after lung and heart-lung transplantation. Methods: A retrospec tive analysis of patient records after lung and heart-lung transplanta tion was performed. A total of 696 patients were identified who receiv ed lung or heart-lung transplants, 64 of whom were found to have granu lation tissue at the site of airway anastomosis (8.9% of 721 airways a t risk). When the granulation tissue was found to narrow the lumen by greater than or equal to 50% and affect lung function. Results: The tr achea was involved in 5 patients and the main stem bronchus in 16. Eac h patient required a mean of 2.6 +/- 2.0 Cryoapplications. Anatomical results of cryotherapy were judged excellent to good in 15 patients an d fair in 6 patients. Eight patients required endobronchial stenting a s part of a multimodality treatment. Overall, the post-treatment FEV1 and FVC increased by 34 +/- 36% and 25 +/- 27% from pre-treatment valu es respectively (P < 0.001). In 13 patients in whom cryotherapy and di lation alone were effective, the FEV1 increased by 41 +/- 43% (range - 11 +/- 138%) and the FVC by 28 +/- 29% (range -4& +/- 96%). These chan ges were also significant (P < 0.001). Changes in these two parameters were positively and significantly correlated (P < 0.01). Acturial sur vival at 3 and at 5 years were 57 and 43%, respectively (NS compared t o total cohort), and median survival was 978 days (range 365-1862). Si x patients are alive at a median follow-up of 5.75 years (range 0.6-8. 3). Conclusions: We conclude that cryotherapy is a safe, effective tre atment for excessive granulation tissue after lung and heart-lung tran splantation and may reduce the need for endobronchial stenting and lim it recurrence. (C) 1997 Elsevier Science B.V.