Long-Term Success of Metal Endobronchial Stents in Lung Transplant Recipients

Author:

Izhakian Shimon1ORCID,Wasser Walter2,Unterman Avraham1,Fruchter Oren3,Gorelik Oleg4,Kramer Mordechai3

Affiliation:

1. Rabin Medical Center, The Pulmonary Institute, Petah Tikva, Israel. Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel

2. Rambam Health Care Campus, Haifa, Israel. Affiliated to Technion - Israel Institute of Technology, Haifa, Israel

3. Edith Wolfson Medical Center, Holon, Israel. Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel

4. Assaf Harofeh Medical Center, Zerifin, Center Israel. Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel

Abstract

Abstract Background Bronchial stenosis is a common complication following lung transplantation. We evaluated long-term associations of the use of self-expandable metal stents (SEMSs) with lung function tests, patient safety, and survival. Methods A retrospective chart review of 582 lung transplantations performed at our institution between January 2002 and January 2018. Fifty-four patients with SEMSs (intervention group) were matched one-to-one to patients without SEMSs (control group) using propensity score matching for age, sex, the year, and type of transplantation (unilateral/bilateral), and underlying disease. Data regarding long-term lung function and survival were compared between the groups. Results During a median follow-up of 54.8 months, the difference in survival between the study groups was not statistically significant (p = 0.2). Following 5, 7.5 and 10 years, values of mean forced expiratory volume in 1 second (FEV1) were comparable between patients with and without SEMSs as follows: 59.5 versus 62.6% (p = 0.2), 55.9 versus 55.0% (p = 0.4), and 63.5 versus 61.9% (p = 0.3), respectively. In the intervention group, a significant increase in the mean FEV1 was observed in 60 days after stent insertion (from 41.9 ± 12.8 to 49.5 ± 16.7% days, p < 0.001). Long-term complications following stent insertion included severe bleeding (1.8%), stent fractures (7.4%), stent stenosis (7.4%), stent collapse (3.7%), endobronchial pressure ulcer (1.9%), and stent migration (1.9%). Conclusion SEMS insertion is associated with a positive sustained effect on lung function, without increasing long-term mortality. Thus, airway stenosis after lung transplantation can be safely and successfully treated using endobronchial metal stenting, with tight bronchoscopic follow-up and maintenance.

Publisher

Georg Thieme Verlag KG

Subject

Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,Surgery

Reference19 articles.

1. Removal and repositioning of “permanent” expandable wire stents in bronchial airway stenosis after lung transplantation;J R Sonett;J Heart Lung Transplant,1998

2. Airway stenoses after lung transplantation: incidence, management, and outcome;P A Thistlethwaite;J Thorac Cardiovasc Surg,2008

3. Deleterious effects of telescoped bronchial anastomosis in single and bilateral lung transplantation;E S Garfein;Ann Transplant,2000

4. Endobronchial metallic stent placement for airway complications after lung transplantation: longitudinal results;K EA Burns;Ann Thorac Surg,2002

5. Airway complications after lung transplantation: treatment and long-term outcome;J M Herrera;Ann Thorac Surg,2001

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