Airway complications after lung transplantation: Treatment and long-term outcome

Background. Airway complications are a significant cause of morbidity after lung transplantation. Effective treatment reduces the impact of these comp lications. Methods. Data from 123 lung (99 single, 24 bilateral) transplants were revi ewed. Potential risk factors for airway complications were analyzed. Stenos es were treated with expanding metal (Gianturco) stents. Results. Mean follow-up was 749 days. Thirty-five complications developed i n 28 recipients (complication rate: 23.8%/anastomosis). Mean time to diagno sis was 47 days. Only Aspergillus infection and airway necrosis were signif icantly associated with development of complications (p < 0.00001 and p < 0 .03, respectively). Stenosis was diagnosed an average of 42 days posttransp lant. Average decline in forced expiratory volume in I second (FEV1) was 39 %. Eighteen patients (13 single and 5 bilateral) required stent insertion. Mean increase in FEV1 poststenting was 87%. Two stent patients died from in fectious complications. Six patients required further intervention. Long-te rm survival and FEV1 did not differ from nonstented patients. Conclusions. Aspergillus and airway necrosis are associated with the develo pment of airway complications. Expanding metal stents are an effective long -term treatment. (C) 2001 by The Society of Thoracic Surgeons.