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Abstract
Introduction Although the rate of airway stenosis following lung transplantation (LT) has reduced dramatically, it is still a significant cause of morbidity and mortality. Traditional self expanding metallic stents (SEMS) carry a high risk of bleeding and hyperplastic granulation tissue formation. Biodegradable stents (BS) present a potential alternative approach that could reduce these complications, though little is currently known about their effectiveness and safety.
Methods A retrospective analysis of our institutions use of 7 BS (polidioxanone) placed in 6 patients who presented bronchial stenoses after LT between December 2011 and January 2013. 2 patients with single (1 right and 1 left) and 4 with bilateral LT. The indications for placing the stents were anastomotic bronchomalacia in 3 cases and bronchial stenoses in 4. The outcomes from these stents were compared with the last 10 patients who have SEMS.
Results Re-stenoses recurred in 3 cases, after 10, 6 and 4 months respectively; 2 responded to balloon dilatation and cryotherapy but 1 patient needed repeat stenting for restenosis. Stent migration occurred in 2 cases. No bleeding was reported. One patient died of obliterative bronchiolitis. The mean increase in FEV1 following treatment was a 312ml increase. Patients required an average of 4.3 (1–9) bronchoscopies following stent insertion. Mean follow up was 12 months and mean survival 27.2 months. These results compare very favourably with a historical comparator group of the last 10 patients who received MS between 2009 and 2012 who required an average of 15.3 bronchoscopies after MS insertion and who had an overall mean drop in FEV1 of 0.59 L. SEMS have been used for a longer period of time, so follow up in this group was 30.5 months and mean survival 34.7 months (Table 1).
Comparison of the outcomes following biodegradable and metallic stents insertion
Conclusion Our data add to the limited literature that BS can be a safe alternative to MS for airway stenosis, and may also represent a useful treatment for anastamotic bronchomalacia.