Safety of hybrid bronchial stents in transplant airway complications: a single center experience

Abstract

Background: Tracheobronchial stents are often used to manage lung transplant airway complications. In 2005, the Food and Drug Administration (FDA) issued a warning against the use of metallic stents for benign airway disease. Since that time, fully covered hybrid metallic stents have been developed and are increasingly used due to their ease of insertion and removal. There is limited data to support their safe utilization for transplant airway complications. This is the largest analysis to date of the safety of hybrid metallic stents for transplant airway complications. Methods:We performed a retrospective study of patients who had covered metallic stents placed for transplant airway complications between April 2016 to April 2021. Information obtained from chart review included demographics, procedure notes and stent data including indication for placement, type, size, location, duration, and complications. Results:We identified 50 patients who had a combined 376 stents placed for a total of 15,711 stent days. The most common minor complication and reason for removal was mucus plugging affecting 193 stents.There were only two cases of major stent associated complications. Among minor complications, there was a increased risk of stent fracture with Bonastent ® (P=0.04). Conclusions:Our data shows that hybrid metallic stents are a safe intervention for patients with transplant airway complications. Most complications were minor and managed with repeat bronchoscopy. There were only two major complications over a 5-year period. Given the wide spectrum of possible airway complications, further research is needed to determine the optimal use of stents for patients with transplant airway complications.

Management of airway complications after lung transplantation: is there an ideal stent?

“…Sinha and colleagues proposed to investigate the results of using covered metallic stents for ACs after LT (5). In a retrospective study at Temple University Hospital (Philadelphia, Pennsylvania) between April 2016 and April 2021, they identified 645 lung transplants.…”

Airway complications—lung transplantation’s Achilles’ heel

“…In this issue of Journal of Thoracic Disease, the Temple University Hospital, Philadelphia Lung Transplant Program detail their experience with airway stenting for transplant airway complications (11). As one of the highest volume lung transplant programs, this report on their approach in this under-published area is much appreciated.…”

“…The main aim of the study was to confirm the safety of their covered metallic stent approach given previous black box warnings against metallic stents in benign airway disease. Sinha et al (11) achieve their aim by demonstrating a low rate of mortality following a stenting procedure with only one death occurring across 376 stents, 15,711 stent days and 774 bronchoscopies. However, what is perhaps most palpable in this report is the morbidity associated with airway complications in lung transplant recipients.…”

“…We thank Sinha et al (11) for detailing their approach to this often buried complication of lung transplantation. Their recent experience highlights that airway complications are not confined to lung transplants of the past.…”

“…The incidence of stenting in this paper, would suggest that the management of anastomotic complications is imminently suited to a multi-centre clinical trial. Off the back of this paper by Sinha et al (11) the lung transplant community should collaborate towards a well-designed clinical trial to generate an evidencebased approach to treating airway complications after lung transplantation. Key to the success of such a trial will be the inclusion of patient reported outcome measures.…”