Large airway complications in 150 consecutive lung transplant recipients

BACKGROUND: Large airway stenosis, and/or bronchomalacia will occur in a subset of lung transplant recipients. We report clinical observations in patients requiring interventional bronchoscopic treatment from the first 150 lung transplant recipients at our institution. METHODS: One hundred and fifty consecutive lung transplant recipients were analyzed retrospectively from the Mayo Clinic Jacksonville Lung Transplant Database. RESULTS: Twenty-five of 150 lung transplant recipients (17%) required intervention by balloon dilatation or stent placement. Survival for patients requiring intervention (I) did not differ from those who did not (NI) at 1, 2, and 3 years. Balloon dilatation with or without stent insertion significantly improved forced expiratory volume in 1 second for group I, increasing from 1.7±0.6 prior insertion to 2.4±0.8 L at 3 months (P=0.007). The median time to first balloon intervention was 98 days. Most patients (74%) who initially required balloon dilatation for airway stenosis ultimately also required stent placement to maintain airway patency. Placement of permanent stents was associated with significant morbidity as most stent recipients required further therapy for granulation tissue growth or fungal colonization within the stent. Nineteen of the 25 patients requiring intervention had underlying idiopathic pulmonary fibrosis (P<0.0001). CONCLUSIONS: Survival at 1, 2, and 3 years did not differ between lung transplant recipients who require intervention versus those who do not, but these complications were associated with significant morbidity and needed frequent interventions. Underlying idiopathic pulmonary fibrosis was the only factor associated with large airway complications in our lung transplant recipients.