The management of bronchus intermedius complications after lung transplantation: A retrospective study

Abstract

BackgroundAirway complications following lung transplantation remain a significant cause of morbidity and mortality. The management of bronchial complications in Bronchus Intermedius (BI) is challenging due to the location of right upper bronchus. The aim of this study was to analyze the results of BI Montgomery T-tube stent in a consecutive patients with lung transplantations.MethodsBetween January 2007 and December 2010, 132 lung transplantations were performed at Foch Hospital, Suresnes, France. All the patients who had BI Montgomery T-tube after lung transplantation were included in this retrospective study. The demographic and interventional data and also complications were recorded.ResultsOut of 132 lung transplant recipients, 12 patients (9 male and 3 female) were entered into this study. The indications for lung transplantation were: cystic fibrosis 8 (67%), emphysema 3 (25%), and idiopathic pulmonary fibrosis 1 (8%). Most of the patients (83%) had bilateral lung transplantation. The mean interval between lung transplantation and interventional bronchoscopy was 11.5 ± 9.8 (SD) months. There was bronchial stenosis at the level of BI in 7 patients (58.3%). The Montgomery T-tube number 10 was used in 9 patients (75%). There was statistically significant difference in Forced Expiratory Volume in one second (FEV1) before and after stent placement (p = 0.01). The most common complication after stent placement was migration (33%).ConclusionBI complications after lung transplantation are still a significant problem. Stenosis or malacia following lung transplantation could be well managed with modified Montgomery T-tube.

Airway Complications After Lung Transplantation

“…46,76,77 Stenting of the bronchus intermedius may be challenging because of the probable occlusion of the right upper lobe; in such case a customized silicone stent or a modified Montgomery T-tube should be used. 78 Sundset and colleagues 79 reported the successful use of silicone stents for stenotic AC, and that, after removal, the airways remained patent and had an improved spirometry value for as long as 24 months.…”

Treating Bronchus Intermedius Stenosis in Lung Transplantation With Montgomery T-tube Stent. A Novel Technique

“…FEV 1 improved significantly after the procedure, while the most common complication was stent migration, reported in one third of the cases. 3 In our patients, we were able to achieve good right bronchus patency, and problems such as obstructions due to secretion or migration were avoided. It seems likely that in the future, these cases will be treated with devices specifically designed for these sites, such as the recently developed Oki 4 stent.…”

Airway complications post lung transplantation

“…Stents in the bronchus intermedius may be problematic due to possible obstruction of the right upper lobe orifice or restenosis at the upper part of the stent. Modified Montgomery T-tubes have been used to avoid occlusion of the right upper lobe [30]. Serious complications of these stents are rare, and after removal of stents, airways typically remain patent and lung function remains improved for as long as 2 years [31 & ].…”