Clinical analysis of therapeutic bronchoscopy in the treatment of central airway stenosis following lung transplantation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

DING Yinfeng ^# , LI Fuqi ^# , HUANG Haidong , DONG Yuchao , ZHANG Wei , SUN Qinying , YAO Xiaopeng ,  BAI Chong

Department of Respiratory and Critical Care Medicine, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, P. R. China;

Corresponding author：

BAI Chong, Email: bc7878@sohu.com

Keywords：

Central airway stenosis; Lung transplantation; Flexible bronchoscopy; Interventional therapy

DOI：

10.7507/1671-6205.202003078

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the clinical efficacy of balloon bronchoplasty and metallic stents in lung transplant-related central airway stenosis.Methods Data of lung transplant recipients with central airway stenosis who underwent therapeutic bronchoscopic interventions between January 2011 and June 2019 at our institution were reviewed. The clinical follow-up included dyspnea index, forced expiratory Forced expiratory volume in one second (FEV₁), six-minute walk distance (6MWD), and the rate of bronchoscopic dilation.Results Thirty-four lung transplant recipients with airway stenosis were included in our study. All these patients were treated by balloon bronchoplasty through flexural bronchoscopy, and 7 additionally needed temporary metal stent implantation for 28 to 67 days in order to palliate recurrent central airway stenosis. The percentages of immediate efficacy were 86% (180/209) and 100% (7/7), respectively. After serial balloon dilatation, the recipients with central airway stenosis had significantly lower dyspnea index (3.24±0.55 vs. 1.91±0.62, P<0.01), higher FEV₁ ［(1.43±0.21)L vs. (1.72±0.27)L, P<0.01］ and longer 6MWD ［(317.3±61.7)m vs. (372.9±52.6)m, P<0.01］. Six recipients with central airway stenosis received 33 interventions in 6 months before stent implantation and 10 interventions in 6 months after stent extraction.Conclusions Lung transplant recipients with central airway stenosis have a good respond to balloon bronchoplasty and stent placement. Airway stenosis after lung transplantation can be successfully managed with bronchoscopic dilatation and temporary stent placement.

Citation： DING Yinfeng, LI Fuqi, HUANG Haidong, DONG Yuchao, ZHANG Wei, SUN Qinying, YAO Xiaopeng, BAI Chong. Clinical analysis of therapeutic bronchoscopy in the treatment of central airway stenosis following lung transplantation. Chinese Journal of Respiratory and Critical Care Medicine, 2020, 19(3): 276-280. doi: 10.7507/1671-6205.202003078 Copy

1.	Santacruz JF, Mehta AC. Airway complications and management after lung transplantation: ischemia, dehiscence, and stenosis. Proc Am Thorac Soc, 2009, 6(1): 79-93.
2.	Frye L, Machuzak M. Airway Complications After Lung Transplantation. Clin Chest Med, 2017, 38(4): 693-706.
3.	Crespo MM, McCarthy DP, Hopkins PM, et al. ISHLT Consensus Statement on adult and pediatric airway complications after lung transplantation: Definitions, grading system, and therapeutics. J Heart Lung Transplant, 2018, 37(5): 548-563.
4.	Mazzetta A, Porzio M, Riou M, et al. Patients treated for central airway stenosis after lung transplantation have persistent airflow limitation. Ann Transplant, 2019, 24: 84-92.
5.	Castleberry AW, Worni M, Kuchibhatla M, et al. A comparative analysis of bronchial stricture after lung transplantation in recipients with and without early acute rejection. Ann Thorac Surg, 2013, 96(3): 1008-1018.
6.	Olland A, Reeb J, Puyraveau M, et al. Bronchial complications after lung transplantation are associated with primary lung graft dysfunction and surgical technique. J Heart Lung Transplant, 2017, 36(2): 157-165.
7.	中华医学会呼吸病学分会. 良性中心气道狭窄经支气管镜介入诊治专家共识. 中华结核和呼吸杂志, 2017, 40(6): 408-418.
8.	丁银锋, 陈龙, 黄海东, 等. 支气管镜介入治疗原发性气管肿瘤的临床分析. 中华结核和呼吸杂志, 2017, 40(6): 435-439.
9.	Stulbarg MS, Adams L. Textbook of respiratory medicine. 5th. Philadelphia: Saunders, 1994, 1-5.
10.	ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002, 166(1): 111-117.
11.	Dhillon GS, Zamora MR, Roos JE, et al. Lung transplant airway hypoxia: a diathesis to fibrosis?. Am J Respir Crit Care Med, 2010, 182(2): 230-236.
12.	Pasnupneti S, Nicolls MR. Airway hypoxia in lung transplantation. Curr Opin Physiol, 2019, 7: 21-26.
13.	Mendogni P, Pieropan S, Rosso L, et al. Impact of cold ischemic time on airway complications after lung transplantation: a single-center cohort study. Transplant Proc, 2019, 51(9): 2981-2985.
14.	Thistlethwaite PA, Yung G, Kemp A, et al. Airway stenoses after lung transplantation: incidence, management, and outcome. J Thorac Cardiovasc Surg, 2008, 136(6): 1569-1575.
15.	Mahajan AK, Folch E, Khandhar SJ, et al. The diagnosis and management of airway complications following lung transplantation. Chest, 2017, 152(3): 627-638.
16.	Greer M, Fuehner T, Warnecke G, et al. Paclitaxel-coated balloons in refractory nonanastomostic airway stenosis following lung transplantation. Am J Transplant, 2014, 14(10): 2400-2405.
17.	Davidson KR, Elmasri M, Wahidi MM, et al. Management of lung transplant bronchial stenosis with mitomycin C. J Bronchology Interv Pulmonol, 2019, 26(2): 124-128.
18.	Abi-Jaoudeh N, Francois RJ, Oliva VL, et al. Endobronchial dilation for the management of bronchial stenosis in patients after lung transplantation: effect of stent placement on survival. J Vasc Interv Radiol, 2009, 20(7): 912-920.
19.	Fortin M, MacEachern P, Hergott CA, et al. Self-expandable metallic stents in nonmalignant large airway disease. Can Respir J, 2015, 22(4): 235-236.
20.	Gottlieb J, Fuehner T, Dierich M, et al. Are metallic stents really safe? A long-term analysis in lung transplant recipients. Eur Respir J, 2009, 34(6): 1417-1422.
21.	Shlomi D, Peled N, Shitrit D, et al. Protective effect of immunosuppression on granulation tissue formation in metallic airway stents. Laryngoscope, 2008, 118(8): 1383-1388.
22.	Abdel-Rahman N, Kramer MR, Saute M, et al. Metallic stents for airway complications after lung transplantation: long-term follow-up. Eur J Cardiothorac Surg, 2014, 45(5): 854-858.

1. Santacruz JF, Mehta AC. Airway complications and management after lung transplantation: ischemia, dehiscence, and stenosis. Proc Am Thorac Soc, 2009, 6(1): 79-93.
2. Frye L, Machuzak M. Airway Complications After Lung Transplantation. Clin Chest Med, 2017, 38(4): 693-706.
3. Crespo MM, McCarthy DP, Hopkins PM, et al. ISHLT Consensus Statement on adult and pediatric airway complications after lung transplantation: Definitions, grading system, and therapeutics. J Heart Lung Transplant, 2018, 37(5): 548-563.
4. Mazzetta A, Porzio M, Riou M, et al. Patients treated for central airway stenosis after lung transplantation have persistent airflow limitation. Ann Transplant, 2019, 24: 84-92.
5. Castleberry AW, Worni M, Kuchibhatla M, et al. A comparative analysis of bronchial stricture after lung transplantation in recipients with and without early acute rejection. Ann Thorac Surg, 2013, 96(3): 1008-1018.
6. Olland A, Reeb J, Puyraveau M, et al. Bronchial complications after lung transplantation are associated with primary lung graft dysfunction and surgical technique. J Heart Lung Transplant, 2017, 36(2): 157-165.
7. 中华医学会呼吸病学分会. 良性中心气道狭窄经支气管镜介入诊治专家共识. 中华结核和呼吸杂志, 2017, 40(6): 408-418.
8. 丁银锋, 陈龙, 黄海东, 等. 支气管镜介入治疗原发性气管肿瘤的临床分析. 中华结核和呼吸杂志, 2017, 40(6): 435-439.
9. Stulbarg MS, Adams L. Textbook of respiratory medicine. 5th. Philadelphia: Saunders, 1994, 1-5.
10. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002, 166(1): 111-117.
11. Dhillon GS, Zamora MR, Roos JE, et al. Lung transplant airway hypoxia: a diathesis to fibrosis?. Am J Respir Crit Care Med, 2010, 182(2): 230-236.
12. Pasnupneti S, Nicolls MR. Airway hypoxia in lung transplantation. Curr Opin Physiol, 2019, 7: 21-26.
13. Mendogni P, Pieropan S, Rosso L, et al. Impact of cold ischemic time on airway complications after lung transplantation: a single-center cohort study. Transplant Proc, 2019, 51(9): 2981-2985.
14. Thistlethwaite PA, Yung G, Kemp A, et al. Airway stenoses after lung transplantation: incidence, management, and outcome. J Thorac Cardiovasc Surg, 2008, 136(6): 1569-1575.
15. Mahajan AK, Folch E, Khandhar SJ, et al. The diagnosis and management of airway complications following lung transplantation. Chest, 2017, 152(3): 627-638.
16. Greer M, Fuehner T, Warnecke G, et al. Paclitaxel-coated balloons in refractory nonanastomostic airway stenosis following lung transplantation. Am J Transplant, 2014, 14(10): 2400-2405.
17. Davidson KR, Elmasri M, Wahidi MM, et al. Management of lung transplant bronchial stenosis with mitomycin C. J Bronchology Interv Pulmonol, 2019, 26(2): 124-128.
18. Abi-Jaoudeh N, Francois RJ, Oliva VL, et al. Endobronchial dilation for the management of bronchial stenosis in patients after lung transplantation: effect of stent placement on survival. J Vasc Interv Radiol, 2009, 20(7): 912-920.
19. Fortin M, MacEachern P, Hergott CA, et al. Self-expandable metallic stents in nonmalignant large airway disease. Can Respir J, 2015, 22(4): 235-236.
20. Gottlieb J, Fuehner T, Dierich M, et al. Are metallic stents really safe? A long-term analysis in lung transplant recipients. Eur Respir J, 2009, 34(6): 1417-1422.
21. Shlomi D, Peled N, Shitrit D, et al. Protective effect of immunosuppression on granulation tissue formation in metallic airway stents. Laryngoscope, 2008, 118(8): 1383-1388.
22. Abdel-Rahman N, Kramer MR, Saute M, et al. Metallic stents for airway complications after lung transplantation: long-term follow-up. Eur J Cardiothorac Surg, 2014, 45(5): 854-858.

Previous Article
Effect of ampelopsin in mice with bleomycin-induced pulmonary fibrosis
Next Article
Effects of sevoflurane on hyperoxia-induced lung injury in rat

Chinese Journal of Respiratory and Critical Care Medicine

Clinical analysis of therapeutic bronchoscopy in the treatment of central airway stenosis following lung transplantation

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content