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14 February 2019 : Original article  

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

Andrea Mazzetta1ABCDEFG, Michele Porzio1ADE, Marianne Riou1ADE, Benjamin Coiffard1ADE, Anne Olland23ADE, Tristan Dégot1ADE, Joseph Seitlinger2ADE, Gilbert Massard23ADE, Benjamin Renaud-Picard13ADE*, Romain Kessler13ACDEFG

DOI: 10.12659/AOT.911923

Ann Transplant 2019; 24:84-92

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 AND 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.

Keywords: airway remodeling, Bronchoscopy, Lung Transplantation, Postoperative Complications, Respiratory Insufficiency

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358