USE OF BALLOON-EXPANDABLE METALLIC STENTS IN THE MANAGEMENT OF BRONCHIAL STENOSIS AND BRONCHOMALACIA AFTER LUNG TRANSPLANTATION

Study objectives: Bronchial stenosis (BS) and bronchomalacia (BM) are often associated with lung allograft rejection or infection in lung tr ansplant (LT) recipients. We reviewed our experience using balloon-exp andable metallic (Palmaz) stents in the management of BS and BM in LT, Design: Retrospective review of cases. Patients: LT recipients with b ronchoscopic and spirometric evidence of BS and BM. Interventions: Ser ial balloon dilation was performed for BS, Stent placement was done fo r refractory or recurrent BS, or persistent focal BM, Results: Twelve of 129 LT bronchial anastomoses at risk (9.3%) had complications, whic h included 11 BS and 5 BM. Four BS were accompanied by BM either concu rrently or subsequently. The only isolated BM was associated with acut e rejection and resolved after appropriate medical therapy. Balloon di lations alone were successful in relieving BS in three cases. Seven pa tients received a total of II stents, Stents were placed under conscio us sedation using a flexible bronchoscope, Five of the seven patients had spirometric improvements after stent placements. One patient had n o spirometric improvement, and another died before a follow-up study w as done. There were no complications during stent placements. However, complications after stent placements included partial dehiscence of t he stent from the bronchial wall, stent migration, partial obstruction of a segmental bronchial orifice by a stent in the main bronchus, and longitudinal stent collapse, One stent was successfully removed using a flexible bronchoscope in the endoscopy suite, and two others were r emoved by rigid bronchoscopy in the operating room. Conclusions: Endob ronchial placement of the Palmaz stent in LT recipients is relatively easy, and it can be removed if needed. However, because there are sign ificant potential complications, the future use of this stent as an ai rway prosthesis in LT remains unclear.