Significance of and Risk Factors for the Development of Central Airway Stenosis After Lung Transplantation

• Published in: American journal of transplantation Vol. 13; no. 2; pp. 383 - 389
• Main Authors: Shofer, S. L., Wahidi, M. M., Davis, W. A., Palmer, S. M., Hartwig, M. G., Lu, Y., Snyder, L. D.
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Wiley 01.02.2013; Elsevier Limited
• Subjects: Adult; Biological and medical sciences; Bronchiolitis Obliterans - diagnosis; Bronchiolitis Obliterans - etiology; Constriction, Pathologic - etiology; Constriction, Pathologic - therapy; Epidemiology; Female; Forced Expiratory Volume; Fungal infections; General aspects; Graft Rejection; Health risk assessment; Humans; Infection; lung transplantation; Lung Transplantation - adverse effects; Lung Transplantation - methods; Male; Medical sciences; Middle Aged; Ostomy; Prognosis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Risk Factors; Spirometry; stenosis; stent; Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Transplantation, Homologous; Transplants & implants; Treatment Outcome; Endoprosthesis; Lung; Stenosis; Instrumentation therapy; Transplantation; Homotransplantation; Respiratory system; Epidemiology; Stent; Infection; Respiratory tract; Surgery; Risk factor; Development; Graft; lung transplantation
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/ajt.12017

Central airways stenosis (CAS) after lung transplant is a poorly understood complication. Objectives of this study were to determine if CAS was associated with chronic rejection or worse survival after transplant as well as to identify factors associated with CAS in a large cohort of lung transplant recipients. Lung transplant recipients transplanted at a single center were retrospectively reviewed for the development of CAS requiring airway dilation. A total of 467 subjects met inclusion criteria with 60 (13%) of these developing CAS requiring intervention. Of these 60 recipients, 22 (37%) had resolution of CAS with bronchoplasty alone, while 32 (53%) ultimately required stent placement. CAS that required intervention was not a risk factor for the development of bronchiolitis obliterans syndrome or worse overall survival. Significant risk factors for the subsequent development of CAS in a time‐dependant multivariable model were pulmonary fungal infections and the need for postoperative tracheostomy. While CAS was not associated with BOS or worse survival, it remains an important complication after lung transplant with potentially preventable risk factors. The authors examine a large single‐center cohort of lung transplantation patients for risk factors for the development of central airway stenosis and find strong associations with fungal infections, postoperative tracheostomy, and prolonged hospitalization after transplant, but not with bronchiolitis obliterans syndrome or acute rejection.