Balloon dilation and endobronchial stent placement for bronchial strictures after lung transplantation

PURPOSE: To evaluate the effect of balloon dilation and endobronchial stent placement for bronchial fibrous stenoses and bronchomalacia after lung tra nsplantation. MATERIALS AND METHODS: Bronchial dilation and/or stent placement was perfor med on 25 lung transplant recipients, Indications included severe dyspnea w ith postobstructive pneumonia (n = 24) and respiratory failure (n = 1), All patients underwent pulmonary function testing (PFT) before and after bronc hial dilation, the results of which were evaluated for changes. A total of 63 procedures were performed between February 1996 and December 1998, Thirt y-five lesions were treated (18 were due to bronchomalacia, 17 were due to fibrosis), Areas treated included the left mainstem bronchus (n = 11), bron chus intermedius (n = 10), right mainstem bronchus (n = 7), left upper lobe bronchus (n = 4), right lower lobe bronchus (n = 2), and right middle lobe bronchus (n = 1), Bronchoscopic and/or bronchographic follow-up ranged fro m 1 to 34 months (mean, 15 months), RESULTS: Six-month primary patency of stents placed for bronchomalacia was 71% (10 of 14), with three of the four occlusions caused by mechanical fail ure of Palmaz stents in the mainstem bronchi, Six-month primary patency for treatment of fibrous strictures was 29%. Secondary patency at 1 year was 1 00% for both bronchomalacia and fibrous strictures. After treatment, there was a significant improvement in mean PFT results (P = .01-.0001). There wa s one acute complication, obstruction of the left lower lobe bronchus by a Wallstent treated by dilating a hole in the side of the stent. CONCLUSIONS: Balloon dilation and stent placement are safe and effective fo r bronchial strictures and bronchomalacia after lung transplantation, resul ting in significant improvement in PFT results. However, there is almost un iversal restenosis in patients treated for fibrous strictures necessitating reintervention for prolonged patency.