The role of self-expandable metallic stents for the treatment of airway complications after lung transplantation

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Abstract
Background. Airway complications continue to be an important source of morbidity and mortality after lung transplantation (LTx). Different approaches have been used for their nonsurgical management. We describe our experience using self-expandable metallic stents (SEMSs) in patients with airway complications post-LTx. Methods. We present a retrospective analysis of stent related-data of all the LTx patients who received SEMSs to treat postoperative airway complications. Results. Between January 1992 and December 2001, 36 of 253 patients (14.2%) developed post-LTx airway complications involving 40 of 348 anastomoses (11.5%). A total of 15 SEMSs were placed in 12 patients (mean age 47.3±9.6 years) for tracheobronchomalacia, stenosis, and anastomotic dehiscence, including one patient referred from an outside hospital. Mean follow-up was 20.1±19.5 months (range 1.2–58 months). Patency and symptom improvement were achieved in 11 of 12 patients. Stenting of the airway led to successful weaning of two patients who were on prolonged mechanical ventilation. Suture dehiscence was effectively managed in two patients who were not candidates for surgical repair. Overall, the complication rate was 0.040 complications per patient per month (total number of complications and total number of months using the stent). Bacterial bronchitis (four patients) and obstructive granulomas (three patients) were the most frequent complications. The survival of LTx patients with airway SEMSs was similar when compared with the survival of all other LTx patients (P =0.74). Conclusions. SEMSs are safe and effective in the management of airway complications in selected patients post-LTx. Weaning from mechanical ventilation and management of anastomotic dehiscence are the unique attributes of this device.