Endobronchial Dilation for the Management of Bronchial Stenosis in Patients after Lung Transplantation: Effect of Stent Placement on Survival
Received 14 October 2008; received in revised form 5 April 2009; accepted 7 April 2009.
Purpose
To compare the outcome of patients treated with balloon dilation and stent placement in the management of bronchial strictures after lung transplantation.
Materials and Methods
Forty-one lung recipients were treated with balloon dilation or stent placement between January 1997 and July 2005. Stent placement was reserved for cases of bronchoplasty technical failure or restenosis. Clinical files and results of pulmonary function tests and bronchoscopic evaluation were reviewed. Dyspnea and cough were defined according to the Breathlessness, Cough, and Sputum Scale. Patient survival and bronchial patency after bronchial intervention were estimated with the Kaplan-Meier method and Cox proportional hazards regression with analysis of stent implantation as a cofactor.
Results
Twenty-three of the 41 patients (56%) received a stent because of balloon dilation failure or stenosis recurrence. A total of 243 procedures were performed in 106 strictures (205 bronchoplasties and 38 stent insertions). At the first session, primary patency was higher in patients treated with stents (71%) than in those who underwent bronchoplasty (19%) (P = .037). Mean survival in patients with stents was longer than that in those who underwent bronchoplasty (82 vs 22 months, respectively), and stent insertion was associated with a 66% reduction in the risk of death (P < .02). Primary patency was 40 months for stented strictures versus 10 months for strictures treated with bronchoplasty (P < .02). Dyspnea and cough were improved after intervention (P < .001), and the forced expiratory volume in 1 second (FEV1) was ameliorated by 17% (P < .00003) at last follow-up.
Conclusions
Clinical outcome and FEV1 were improved after bronchoplasty and stent placement. Longer patient survival and bronchial patency were observed after stent insertion.
aDepartment of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM) Hôpital Notre-Dame and Université de Montréal, 1560 Sherbrooke St East, Montreal, Quebec, Canada H2L 4M1
bDepartment of Pneumology, Centre Hospitalier de l'Université de Montréal (CHUM) Hôpital Notre-Dame and Université de Montréal, 1560 Sherbrooke St East, Montreal, Quebec, Canada H2L 4M1
cDepartment of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM) Hôpital Notre-Dame and Université de Montréal, 1560 Sherbrooke St East, Montreal, Quebec, Canada H2L 4M1
Address correspondence to G.S.
This work was supported by a clinical research scholarship (to G.S.) from Fonds de la recherche en santé du Québec (FRSQ).
None of the authors have identified a conflict of interest.
ABSTRACT