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DOI: 10.1055/s-2004-861563
Interventional Techniques in the Management of Airway Complications Following Lung Transplantation
Publication History
Publication Date:
07 January 2005 (online)
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ABSTRACT
The last four decades have seen tremendous advances in the field of pulmonary transplantation. Vast improvements in the areas of surgical transplantation techniques, immunosuppressive agents, and postoperative care have all contributed to improved survival of patients. Advances in noninvasive imaging and bronchoscopy have allowed the pulmonary transplant team to intervene early in patients presenting with airway complications, often using minimally invasive procedures such as endobronchial balloon dilation or stent placement, or both. Stent technology itself has also improved and stents may sometimes be customized for treatment of short airway lesions or to optimize continued airflow through the sides of stents by creating openings using balloons or bronchoscopically directed laser. Preliminary work with brachytherapy may be decreasing the need for secondary reinterventions. The authors present an overview of some of these conventional and novel approaches to the treatment of airway complications after lung transplantation.
KEYWORDS
Lung transplantation - bronchus - stenosis
REFERENCES
- 1 Hardy J, Webb W, Dalton M et al.. Lung homotransplantations in man. JAMA. 1963; 186 1065-1074
- 2 Hardy J D. The first lung transplant in man (1963) and the first heart transplant in man (1964). Transplant Proc. 1999; 31 25-29
-
3 Based on Organ Procurement and Transplantation Network data as of January 12 2004
- 4 Barr M L, Schenkel R G, Cohen R G et al.. Recipient and donor outcomes in living related and unrelated lobar transplantation. Transplant Proc. 1998; 30 2261-2263
- 5 Grover F L, Fullerton D A, Zamora M R et al.. The past, present, and future of lung transplantation. Am J Surg. 1997; 173 523-533
- 6 Derom F, Barbier F, Ringoi S et al.. Ten month survival after lung homotransplantations in man. J Thorac Cardiovasc Surg. 1971; 61 835-846
- 7 Veith F J, Kambolg S L, Mollenkopf F P, Montefusco C M. Lung transplantation. Transplantation. 1983; 35 271-278
- 8 Schafers H J, Haydock D A, Cooper J D. The prevalence and management of bronchial anastomotic complications in lung transplantation. J Thorac Cardiovasc Surg. 1991; 101 1044-1052
- 9 Lau C L, Patterson G A. Technical considerations in lung transplantation. Chest Surg Clin N Am. 2003; 13 463-483
- 10 Meyers B F, Patterson G A. Technical aspects of adult lung transplantation. Semin Thorac Cardiovasc Surg. 1998; 10 213-220
- 11 Patterson G A. Bilateral lung transplant: indications and technique. Semin Thorac Cardiovasc Surg. 1992; 4 95-100
- 12 Patterson G A, Cooper J D, Goldman B et al.. Technique of successful clinical double-lung transplantation. Ann Thorac Surg. 1988; 45 626-633
- 13 Cooper J D, Pearson F G, Patterson G A et al.. Technique of successful lung transplantation in humans. J Thorac Cardiovasc Surg. 1987; 93 173-181
- 14 van den Berg J WK, Postma D S, Koeter G H, van der Bij W. New immunosuppressive drugs and lung transplantation: last or least?. Thorax. 1999; 54 550-553
- 15 Lima O, Cooper J D, Peters W J et al.. Effects of methylprednisolone and azathioprine on bronchial healing following lung autotransplantation. J Thorac Cardiovasc Surg. 1981; 82 211-215
- 16 Goldberg M, Lima O, Morgan E et al.. A comparison between cyclosporine A and methylprednisolone plus azathioprine on bronchial healing following canine lung autotransplantation. J Thorac Cardiovasc Surg. 1983; 85 821-826
- 17 Dransfield M T, Garver R I, Weill D. Standardized guidelines for surveillance bronchoscopy reduce complications in lung transplant recipients. J Heart Lung Transplant. 2004; 23 110-114
- 18 Westall G P, Michaelides A, Williams T J, Snell G I, Kotsimbos T C. Bronchiolitis obliterans syndrome and early human cytomegalovirus DNAaemia dynamics after lung transplantation. Transplantation. 2003; 75 2064-2068
- 19 Corris P A. Lung transplantation. Bronchiolitis obliterans syndrome. Chest Surg Clin N Am. 2003; 13 543-557
- 20 Boehler A, Estenne M. Obliterative bronchiolitis after lung transplantation. Curr Opin Pulm Med. 2000; 6 133-139
- 21 Wildevuur C R, Benfield J R. A review of 23 human lung transplantations by 20 surgeons. Ann Thorac Surg. 1970; 9 489-515
- 22 Kshettry V R, Kroshus T J, Hertz M I et al.. Early and late airway complications after lung transplantation: incidence and management. Ann Thorac Surg. 1997; 63 1576-1583
- 23 Herrera J M, McNeil K D, Higgins R SD et al.. Airway complications after lung transplantation: treatment and long-term outcome. Ann Thorac Surg. 2001; 71 989-994
- 24 Date H, Trulock E P, Arcidi J M, Sundaresan S, Cooper J D, Patterson G A. Improved airway healing after lung transplantation. An analysis of 348 bronchial anastomoses. J Thorac Cardiovasc Surg. 1995; 110 1424-1433
- 25 Couraud L, Nashef S A, Nicolini P, Jougon J. Classification of airway anastomotic healing. Eur J Cardiothorac Surg. 1992; 6 496-497
- 26 Norgaard M A, Andersen C B, Pettersson G. Does bronchial artery revascularization influence results concerning bronchiolitis obliterans syndrome and/or obliterative bronchiolitis after lung transplantation?. Eur J Cardiothorac Surg. 1998; 14 311-318
- 27 Norgaard M A, Andersen C B, Pettersson G. Airway epithelium of transplanted lungs with and without direct bronchial artery revascularization. Eur J Cardiothorac Surg. 1999; 15 37-44
- 28 Siegelmann S S, Hagstrom J WC, Koerner S K, Veith F J. Restoration of bronchial artery circulation after canine lung allograft transplantation. J Thorac Cardiovasc Surg. 1977; 73 792-795
- 29 Mulligan M S. Endoscopic management of airway complications after lung transplantation. Chest Surg Clin N Am. 2001; 11 907-915
- 30 Couraud L, Bauded E, Nashef S AM et al.. Lung transplantation with bronchial revascularization. Eur J Cardiothorac Surg. 1992; 6 490-495
- 31 Cauldwell E W, Siekert R G, Lininger R E, Anson B J. The bronchial arteries: an anatomic study of 150 human cadavers. Surg Gynecol Obstet. 1948; 86 395-412
- 32 Morgan E, Lima O, Goldberg M, Ferdman A, Luk S K, Cooper J D. Successful revascularization of totally ischemic bronchial autograft with omental pedicle flaps in dogs. J Thorac Cardiovasc Surg. 1982; 84 204-210
- 33 Fell S C, Mollenkopf F P, Montefusco C M et al.. Revascularization of ischemic bronchial anastomosis by an intercostal pedicle flap. J Thorac Cardiovasc Surg. 1985; 90 172-178
- 34 Pinkser K L, Koerner S K, Kamholz S L, Hagstrom J WC, Veith F J. Effect of donor bronchial length on healing: a canine model to evaluate bronchial anastomotic problems in lung transplantation. J Thorac Cardiovasc Surg. 1979; 77 669-673
- 35 Schafers J H, Haverich A, Wagner T OF, Wahler T, Alken A, Borst H G. Decreased incidence of bronchial complications following lung transplantation. Eur J Cardiothorac Surg. 1992; 6 174-179
- 36 Chhajed P N, Malouf M A, Tamm M, Spratt P, Glanville A R. Interventional bronchoscopy for the management of airway complications following lung transplantation. Chest. 2001; 120 1894-1899
- 37 Orons P D, Amesur N B, Dauber J H, Zajko A B, Keenan R J, Iacono A T. Balloon dilation and endobronchial stent placement for bronchial strictures after lung transplantation. J Vasc Interv Radiol. 2000; 11 89-99
- 38 Burns K E, Orons P D, Dauber J H et al.. Endobronchial metallic stent placement for airway complications after lung transplantation: longitudinal results. Ann Thorac Surg. 2002; 74 1934-1941
- 39 Kazerooni E A, Chow L C, Whyte R I et al.. Preoperative examination of lung transplant candidates: value of chest CT compared with chest radiography. AJR Am J Roentgenol. 1995; 165 1343-1348
- 40 Collins J. Imaging of the chest after lung transplantation. J Thorac Imaging. 2002; 17 102-112
- 41 Collins J, Kuhlman J E, Love R B. Acute, life-threatening complications of lung transplantation. Radiographics. 1998; 18 21-43
- 42 Konen E, Yellin A, Greenber I et al.. Complications of tracheal and thoracic surgery: the role of multisection helical CT and computerized reformations. Clin Radiol. 2003; 58 341-350
- 43 Collins J, Hartman M J, Warner T F et al.. Frequency and CT findings of recurrent disease after lung transplantation. Radiology. 2001; 219 503-509
- 44 Schlueter F J, Semenkovich J W, Glazer H S, Arcidi J M, Trulock E P, Patterson G A. Bronchial dehiscence after lung transplantation: correlation of CT findings with clinical outcomes. Radiology. 1996; 199 849-854
- 45 Semenkovich J W, Glazer H S, Anderson D J, Arcidi J, Cooper J D, Patterson G A. Bronchial dehiscence in lung transplantation: CT evaluation. Radiology. 1995; 194 205-208
- 46 Siegel M J, Bhalla S, Gutierrez F R, Hildebolt C, Sweet S. Post-lung transplantation bronchiolitis obliterans syndrome: usefulness of expiratory thin- section CT for diagnosis. Radiology. 2001; 220 455-462
- 47 McAdams H P, Erasmus J J, Palmer S M. Complications (excluding hyperinflation) involving the native lung after single-lung transplantation: incidence, radiologic features, and clinical importance. Radiology. 2001; 218 233-241
- 48 Hearne S E, O'Laughlin M P, Davis R D, Baker W A, Bashore T M, Harrison J K. Total pulmonary artery occlusion immediately after lung transplantation: successful revascularization with intravascular stents. J Heart Lung Transplant. 1996; 15 532-535
- 49 Berger H, Steiner W, Schmidt D, Forst H, Dienemann H. Stent-angioplasty of an anastomotic stenosis of the pulmonary artery after lung transplantation. Eur J Cardiothorac Surg. 1994; 8 103-105
- 50 Yoon H, Huddleston C B, Miyoshi S, Matsuda H, Kamiike W, Patterson G A. Pulmonary function after living donor lung transplantation. Transplant Proc. 2001; 33 1626-1627
- 51 Sritippayawan S, Keens T G, Horn M V, Starnes V A, Woo M S. What are the best pulmonary function test parameters for early detection of post-lung transplant bronchiolitis obliterans syndrome in children?. Pediatr Transplant. 2003; 7 200-203
- 52 Trulock E P. Flexible bronchoscopy in lung transplantation. Clin Chest Med. 1999; 20 77-87
- 53 Rio B, Guesde R, Jacquens Y et al.. Fiberoptic bronchoscopy in brain-dead organ donors. Am J Respir Crit Care Med. 1994; 150 558-560
- 54 Kukafka D S, O’Brien G M, Furukawa S, Criner G. Surveillance bronchoscopy in lung transplant recipients. Chest. 1997; 111 377-381
- 55 Iacono A T, Corcoran T E, Griffith B P et al.. Aerosol cyclosporin therapy in lung transplant recipients with bronchiolitis obliterans. Eur Respir J. 2004; 23 384-390
- 56 Corcoran T E, Smaldone G C, Dauber J H et al.. Preservation of post-transplant lung function with aerosol cyclosporine. Eur Respir J. 2004; 23 378-383
- 57 Baz M A, Layish D T, Govert J A et al.. Diagnostic yield of bronchoscopies after isolated lung transplantation. Chest. 1996; 110 84-88
- 58 Kelly W F, Sanghani S, Barnett S D, Burton N, Nathan S. Significance of early bronchoscopic airway abnormalities after lung transplantation. J Heart Lung Transplant. 2003; 22 583-586
- 59 Spatenka J, Khaghani A, Irving J D, Theodoropoulos S, Slavik Z, Yacoub M H. Gianturco self-expanding metallic stents in treatment of tracheobronchial stenosis after single lung and heart and lung transplantation. Eur J Cardiothorac Surg. 1991; 5 648-652
- 60 Carre P, Rousseau H, Lombart L et al.. Balloon dilatation and self-expanding metal Wallstent insertion. For management of bronchostenosis following lung transplantation. The Toulouse Lung Transplantation Group. Chest. 1994; 105 343-348
- 61 Higgins R, McNeil K, Dennis C et al.. Airway stenoses after lung transplantation: management with expanding metal stents. J Heart Lung Transplant. 1994; 13 774-778
- 62 Sonett J R, Keenan R J, Ferson P F, Griffith B P, Landreneau R J. Endobronchial management of benign, malignant, and lung transplantation airway stenoses. Ann Thorac Surg. 1995; 59 1417-1422
- 63 Susanto I, Peters J I, Levine S M, Sako E Y, Anzueto A, Bryan C L. Use of balloon-expandable metallic stents in the management of bronchial stenosis and bronchomalacia after lung transplantation. Chest. 1998; 114 1330-1335
- 64 Lonchyna V A, Arcidi Jr J M, Garrity Jr E R et al.. Refractory post-transplant airway strictures: successful management with wire stents. Eur J Cardiothorac Surg. 1999; 15 842-849
- 65 Mulligan M S. Endoscopic management of airway complications after lung transplantation. Chest Surg Clin N Am. 2001; 11 907-915
- 66 Chhajed P N, Malouf M A, Tamm M, Glanville A R. Ultraflex stents for the management of airway complications in lung transplant recipients. Respirology. 2003; 8 59-64
- 67 Perini S, Gordon R, Golden J et al.. Deformation and migration of Palmaz stents after placement in the tracheobronchial tree. J Vasc Interv Radiol. 1999; 10 209-215
- 68 Sonett J R, Conte J V, Orens J, Krasna M. Removal and repositioning of “permanent” expandable wire stents in bronchial airway stenosis after lung transplantation. J Heart Lung Transplant. 1998; 17 328-330
- 69 Susanto I, Peters J I, Levine S M, Sako E Y, Anzueto A, Bryan C L. Use of balloon-expandable metallic stents in the management of bronchial stenosis and bronchomalacia after lung transplantation. Chest. 1998; 114 1330-1335
- 70 Saad C P, Ghamande S A, Minai O A et al.. The role of self-expandable metallic stents for the treatment of airway complications after lung transplantation. Transplantation. 2003; 75 1532-1538
- 71 Burns K E, Iacono A T. Incidence of clinically unsuspected pulmonary embolism in mechanically ventilated lung transplant recipients. Transplantation. 2003; 76 964-968
- 72 Clark S C, Levine A J, Hasan A, Hilton C J, Forty J, Dark J H. Vascular complications of lung transplantation. Ann Thorac Surg. 1996; 61 1079-1082
- 73 Waurick P E, Kleber F X, Ewert R et al.. Pulmonary artery stenosis 5 years after single lung transplantation in primary pulmonary hypertension. J Heart Lung Transplant. 1999; 18 1243-1245
- 74 Pearson F G, Goldberg M, Stone R M, Colapinto R F. Bronchial arterial circulation restored after reimplantation of canine lung. Can J Surg. 1970; 13 243-250
- 75 Schoenberger J A, Darcy M D. Bronchial artery embolization for hemoptysis in a lung transplant recipient. J Vasc Interv Radiol. 1995; 6 354-356
- 76 Kennedy A S, Sonett J R, Orens J B, King K. High dose rate brachytherapy to prevent recurrent benign hyperplasia in lung transplant bronchi: theoretical and clinical considerations. J Heart Lung Transplant. 2000; 19 155-159
- 77 Halkos M E, Godette K D, Lawrence E C, Miller Jr J I. High dose rate brachytherapy in the management of lung transplant airway stenosis. Ann Thorac Surg. 2003; 76 381-384
Nikhil B AmesurM.D.
Assistant Professor of Radiology, University of Pittsburgh Medical Center
200 Lothrop Street, Childrens Main Tower 4886
Pittsburgh, PA 15213