HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (26) Citing Articles via Google Scholar Google Scholar Articles by Chhajed, P. N. Articles by Glanville, A. R. Search for Related Content PubMed PubMed Citation Articles by Chhajed, P. N. Articles by Glanville, A. R.

Interventional Bronchoscopy for the Management of Airway Complications Following Lung Transplantation^*

^* From the Heart Lung Transplant Unit, St. Vincent’s Hospital, Sydney, Australia.

Correspondence to: Prashant N. Chhajed, MD, DNB, FCCP, Heart Lung Transplant Unit, St. Vincent’s Hospital, deLacy Building, Level 14, Victoria St, Darlinghurst, NSW 2010, Sydney, Australia; e-mail: chhajed{at}hotmail.com

Study objectives: To assess the efficacy and complications of different interventional bronchoscopic techniques used to treat airway complications after lung transplantation.

Design: Retrospective study.

Setting: Heart-lung transplant unit of a university hospital.

Patients: From November 1986 to January 2000, interventional bronchoscopy was performed in 41 of 312 lung transplant recipients (13.1%) for tracheobronchial stenosis, bronchomalacia, granuloma formation, and dehiscence.

Interventions: Dilatation, stent placement, laser or forceps excision.

Measurements and results: Mean (± SE) improvement in FEV₁ in 26 patients undergoing dilatation for a stenotic or a combined lesion was 93 ± 334 mL or 8 ± 21%. In seven of these patients not proceeding to stent placement, mean improvement in FEV₁ was 361 ± 179 mL or 21 ± 9%. Patients needing stent placement after dilatation had a mean change in FEV₁ after dilatation of - 5 ± 325 mL or 3 ± 23%, and an improvement of 625 ± 480 mL or 52 ± 43% after stent insertion. Mean improvement in FEV₁ for patients treated with stent insertion for bronchomalacia was 673 ± 30 mL or 81 ± 24%. Complications of airway stents were migration (27%), mucous plugging (27%), granuloma formation (36%), stent fracture (3%), and formation of a false passage (6%). Mortality associated with interventional bronchoscopy was 2.4% (1 of 41 patients). For patients with airway complications successfully undergoing interventional bronchoscopy, the overall 1-year, 3-year, and 5-year survival rates were 79%, 45%, and 32%, respectively, vs 87%, 69%, and 56% for those without airway complications (p < 0.05).

Conclusion: Only a small number of patients with airway stenosis after lung transplantation will respond to bronchial dilatation alone. Patients with airway complications after lung transplantation have a higher mortality than patients without airway complications.

Key Words: airway stenosis • bronchomalacia • dilatation • fiberoptic bronchoscopy • interventional bronchoscopy • lung transplantation • stent

This article has been cited by other articles:

				P. N. Chhajed, R. Eberhardt, H. Dienemann, A. Azzola, M. H. Brutsche, M. Tamm, and F. J.F. Herth Therapeutic bronchoscopy interventions before surgical resection of lung cancer. Ann. Thorac. Surg., May 1, 2006; 81(5): 1839 - 1843. [Abstract] [Full Text] [PDF]

				M. M. Mughal, T. R. Gildea, S. Murthy, G. Pettersson, M. DeCamp, and A. C. Mehta Short-Term Deployment of Self-Expanding Metallic Stents Facilitates Healing of Bronchial Dehiscence Am. J. Respir. Crit. Care Med., September 15, 2005; 172(6): 768 - 771. [Abstract] [Full Text] [PDF]

				R. M. Kotloff, V. N. Ahya, and S. W. Crawford Pulmonary Complications of Solid Organ and Hematopoietic Stem Cell Transplantation Am. J. Respir. Crit. Care Med., July 1, 2004; 170(1): 22 - 48. [Abstract] [Full Text] [PDF]

				P. N. Chhajed, M. Brutsche, and M. Tamm Balloon Dilatation Using Flexible Bronchoscopy for the Management of Benign and Malignant Airway Stenoses Chest, January 1, 2004; 125(1): 354 - 355. [Full Text] [PDF]

				C. P. Saad, S. Murthy, G. Krizmanich, and A. C. Mehta Self-Expandable Metallic Airway Stents and Flexible Bronchoscopy: Long-term Outcomes Analysis Chest, November 1, 2003; 124(5): 1993 - 1999. [Abstract] [Full Text] [PDF]

				M. E. Halkos, K. D. Godette, E. C. Lawrence, and J. I. Miller Jr High dose rate brachytherapy in the management of lung transplant airway stenosis Ann. Thorac. Surg., August 1, 2003; 76(2): 381 - 384. [Abstract] [Full Text] [PDF]