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Ann Thorac Surg 2001;71:989-993
© 2001 The Society of Thoracic Surgeons

Original article: general thoracic

Airway complications after lung transplantation: treatment and long-term outcome

José M. Herrera, MDa, Keith D. McNeil, FRACPa, Robert S.D. Higgins, MDa, Richard A. Coulden, FRCRb, Christopher D. Flower, FRCRb, Samer A.M. Nashef, FRCSa, John Wallwork, FRCSa

a Transplant Unit, Papworth Hospital, Cambridge, United Kingdom
b Department of Radiology, Papworth Hospital, Cambridge, United Kingdom

Accepted for publication May 31, 2000.

Address reprint requests to Dr McNeil, Papworth Hospital, Papworth Everard, Cambridge, CB3 8RE, UK
e-mail: keith.mcneil{at}papworth-tr.anglox.nhs.uk

Background. Airway complications are a significant cause of morbidity after lung transplantation. Effective treatment reduces the impact of these complications.

Methods. Data from 123 lung (99 single, 24 bilateral) transplants were reviewed. Potential risk factors for airway complications were analyzed. Stenoses were treated with expanding metal (Gianturco) stents.

Results. Mean follow-up was 749 days. Thirty-five complications developed in 28 recipients (complication rate: 23.8%/anastomosis). Mean time to diagnosis was 47 days. Only Aspergillus infection and airway necrosis were significantly associated with development of complications (p < 0.00001 and p < 0.03, respectively). Stenosis was diagnosed an average of 42 days posttransplant. Average decline in forced expiratory volume in 1 second (FEV1) was 39%. Eighteen patients (13 single and 5 bilateral) required stent insertion. Mean increase in FEV1 poststenting was 87%. Two stent patients died from infectious complications. Six patients required further intervention. Long-term survival and FEV1 did not differ from nonstented patients.

Conclusions. Aspergillus and airway necrosis are associated with the development of airway complications. Expanding metal stents are an effective long-term treatment.


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