Patients Treated for Central Airway Stenosis After Lung Transplantation Have Persistent Airflow Limitation

Abstract

Background Although central airway stenosis (CAS) is a common complication after lung transplantation, its consequences have been poorly evaluated. The objective of our study was to evaluate the impact of CAS on lung function after lung transplantation. Material/Methods All lung transplant recipients from June 2009 to August 2014 in a single center (Strasbourg, France) were retrospectively reviewed. Results A total of 191 lung transplantations were performed: 175 bilateral, 15 single, and 1 heart-lung transplantation. Of the 161 bilateral lung-transplanted patients who survived >3 months, 22 (13.6%) developed CAS requiring endobronchial treatment. All these patients were treated by endoscopic balloon dilatation, and 9 additionally needed endobronchial stents. Respiratory function tests demonstrated persistent obstructive ventilatory pattern despite endoscopic treatment in recipients with CAS compared to those without CAS at 6, 12, and 18 months post-transplant. At 18 months, CAS patients had significantly lower post-transplant FEV1 (1.96±0.60 L versus 2.57±0.76 L, p=0.001) and FEV1/FVC (61±14% versus 81±13%, p<0.001). The percentage of patients hospitalized for respiratory infections and number of hospital days were significantly increased in recipients with CAS (20 [91%] versus 92 [66%] p=0.036, and 144±110 days versus 103±83 days p=0.042, respectively). Survival in transplant recipients did not significantly differ between those with CAS and those without. Conclusions CAS after lung transplantation was not associated with worse survival, but it did have a significant and persistent effect on lung function, and was associated with increased rate of respiratory infection.

Number of Bronchoscopic Interventions in Lung Transplant Recipients Correlates with Respiratory Function Assessed by Pulmonary Function Tests

“…Our study revealed that in patients who required ≥1 BI during their first post-transplant year, spirometry parameters were statistically significantly lower than in patients who did not need such bronchoscopic treatment. A similar finding was reported by Mazzetta et al [ 8 ], who found that patients with central AS so severe it required BI had lower FEV 1 (L) and FEV 1 /FVC at 18-month follow-up (81±13% versus 61±14%, P <0.001).…”

“…We also reported a statistically significant difference between our study groups in FEV 1 (%) between our study groups (81±27% versus 54±21%, P <0.001) and FEV 1 /FVC (78±18% versus 62±32%, P =0.004). Mazzetta et al also showed that CAS does not affect the survival of lung transplant recipients [ 8 ]. That is supported by a paper published by Shofer et al [ 7 ].…”

“…Bronchoscopic interventions (BIs) available include balloon bronchoplasty, cryotherapy, argon plasma coagulation, and laser therapy; in some cases, airway stenting is a last resort [ 4 ]. Even though AS does not influence survival in graft recipients, it can cause persistent airflow limitation despite frequent use of BIs [ 8 ]. Questions remain about whether BIs used to treat AS can improve a patient’s ventilation permanently and whether these measures can improve spirometry results such that they are comparable to those in lung recipients who do not have AS.…”

Hybrid reconstruction of bronchial dehiscence following lung transplant

“…Sleeve resections have been successfully utilized for these complex situations 2‐4 . We preferred to preserve the entire graft to prevent long term decline in lung function as observed in patients with central airway stenosis 7 …”

“…[2][3][4] We preferred to preserve the entire graft to prevent long term decline in lung function as observed in patients with central airway stenosis. 7…”