AIRWAY STENOSES AFTER LUNG TRANSPLANTATION - MANAGEMENT WITH EXPANDING METAL STENTS

Success in lung transplantation has been hindered by airway complicati ons, usually as a result of anastomotic ischemia and stenosis. We repo rt our experience with expanding metal stents in managing airway steno ses after lung transplantation. From April 1984 through November 1993, 46 single lung, 5 double lung, and 154 heart-lung transplantations we re performed at Papworth Hospital. All patients received immunosuppres sion with azathioprine, cyclosporine, methylprednisolone, and inductio n antithymocyte globulin. Fourteen patients (nine single lung, two dou ble lung, and three heart-lung) had an airway stenosis requiring a ste nt. The most common features were shortness of breath, wheezing or str idor, and a fall in pulmonary function tests (11 patients). Three pati ents had pneumonia. Airway stenosis was diagnosed on bronchoscopy an a verage of 61 days after transplantation (range 3 to 245 days). Stent p lacement occurred an average of 18 days after the diagnosis (range 2 t o 84 days). One heart-lung transplant recipient received a silicone ru bber stent. All other patients received expanding metal stents. Six pa tients required multiple stent placements. After stent placement the a verage increase in the forced expiratory volume in 1 second was 117%. Infection complicated the stenoses in 12 patients. Pseudomonas aerugin osa and Aspergillus fumigatus were the most common pathogens, each occ urring in six cases. Multiple pathogens were isolated in seven cases. Three patients died as a direct consequence of their airway problems. Two died of pneumonia despite stenting, and a third died of acute occl usion of the silicone rubber stent. Expanding metal stents are an effe ctive treatment of airway stenoses in lung transplant recipients. Pati ents with suspected airway problems should be referred for early bronc hoscopy with the potential for stent placement.