Post-transplant bronchial stenosis: a single center retrospective study

SESSION TITLE: Lung Transplantation: New Issues in 2022SESSION TYPE: Rapid Fire Original InvPRESENTED ON: 10/19/2022 11:15 am - 12:15 pmPURPOSE: Bronchial stenosis is an important complication after lung transplantation with an incidence rate of up to 32% in previous studies.METHODS: Among a cohort of 246 lung transplant recipients at our center, we identified 14 patients with bronchial stenosis for an incidence of 5.7%.RESULTS: Average age at transplant was 64.6 years with a range of 55 to 73 years. Seven recipients were male and seven were female. Our cohort had four single lung transplants (three right, one left) and ten bilateral lung transplants. Six cases were central airway stenosis, six distal airway stenosis and two mixed airway stenosis. Preceding their stenosis, 11 patients developed tracheobronchitis, and five of our patients had parenchymal lung infections. Three of our patients also had A1 rejection. Management of our cohort included balloon dilation, cryodebulking, laser therapy, antiproliferative injections, and stenting. Within our cohort, 11 patients underwent at least one balloon dilation of their stenosis. Three patients had cryodebulking of their stenosis. Three patients received laser therapy, and two patients received antiproliferative injections in their stenoses. Five of our patients required further management with at least one stent. Stent complications in our cohort included stent migration, stent infection, mucus plugging and granulation tissue overgrowth. One patient’s stenosis was refractory to all these modalities, so the decision to proceed with pulmonary sleeve resection was made.CONCLUSIONS: Our center’s experience with post-transplant bronchial stenosis differs from the literature in that our prevalence is much lower, however, there are many consistencies with previously published literature such as infections like tracheobronchitis and parenchymal lung infections preceding development of bronchial stenosis. Cellular rejection has previously been identified as an additional risk factor preceding bronchial stenosis. Only one mortality was directly attributable to bronchial stenosis. The extent of disease was particularly aggressive in this subject who had prolonged refractory shock early post-transplant. Traditional management of bronchial stenosis can be performed with the various non-surgical modalities identified above, but our management with a pulmonary sleeve resection for refractory bronchial stenosis should be considered early on as another potential option.CLINICAL IMPLICATIONS: We review clinical characteristics, management and outcomes of bronchial stenosis in our lung transplant population.DISCLOSURES: No relevant relationships by Phillip CampNo relevant relationships by John EganNo relevant relationships by Austin Frischresearch relationship with United Therapeutics Please note: 2016- ongoing by Reda Girgis, value=Grant/Researchresearch relationship with Pfizer Please note: 2014-2020 by Reda Girgis, value=Grant/ResearchSpeaker/Speaker's Bureau relationship with Boehringher Ingelheim Please note: 2016-ongoing by Reda Girgis, value=HonorariaSpeaker/Speaker's Bureau relationship with Genentech Please note: 2016-ongoing by Reda Girgis, value=HonorariaNo relevant relationships by Ryan HadleyNo relevant relationships by Sheila KrishnanNo relevant relationships by Lindsey LeQuiaNo relevant relationships by Edward MurphyNo relevant relationships by Gayathri SathiyamoorthyNo relevant relationships by Ranuka Sinniah SESSION TITLE: Lung Transplantation: New Issues in 2022 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Bronchial stenosis is an important complication after lung transplantation with an incidence rate of up to 32% in previous studies. METHODS: Among a cohort of 246 lung transplant recipients at our center, we identified 14 patients with bronchial stenosis for an incidence of 5.7%. RESULTS: Average age at transplant was 64.6 years with a range of 55 to 73 years. Seven recipients were male and seven were female. Our cohort had four single lung transplants (three right, one left) and ten bilateral lung transplants. Six cases were central airway stenosis, six distal airway stenosis and two mixed airway stenosis. Preceding their stenosis, 11 patients developed tracheobronchitis, and five of our patients had parenchymal lung infections. Three of our patients also had A1 rejection. Management of our cohort included balloon dilation, cryodebulking, laser therapy, antiproliferative injections, and stenting. Within our cohort, 11 patients underwent at least one balloon dilation of their stenosis. Three patients had cryodebulking of their stenosis. Three patients received laser therapy, and two patients received antiproliferative injections in their stenoses. Five of our patients required further management with at least one stent. Stent complications in our cohort included stent migration, stent infection, mucus plugging and granulation tissue overgrowth. One patient’s stenosis was refractory to all these modalities, so the decision to proceed with pulmonary sleeve resection was made. CONCLUSIONS: Our center’s experience with post-transplant bronchial stenosis differs from the literature in that our prevalence is much lower, however, there are many consistencies with previously published literature such as infections like tracheobronchitis and parenchymal lung infections preceding development of bronchial stenosis. Cellular rejection has previously been identified as an additional risk factor preceding bronchial stenosis. Only one mortality was directly attributable to bronchial stenosis. The extent of disease was particularly aggressive in this subject who had prolonged refractory shock early post-transplant. Traditional management of bronchial stenosis can be performed with the various non-surgical modalities identified above, but our management with a pulmonary sleeve resection for refractory bronchial stenosis should be considered early on as another potential option. CLINICAL IMPLICATIONS: We review clinical characteristics, management and outcomes of bronchial stenosis in our lung transplant population. DISCLOSURES: No relevant relationships by Phillip Camp No relevant relationships by John Egan No relevant relationships by Austin Frisch research relationship with United Therapeutics Please note: 2016- ongoing by Reda Girgis, value=Grant/Research research relationship with Pfizer Please note: 2014-2020 by Reda Girgis, value=Grant/Research Speaker/Speaker's Bureau relationship with Boehringher Ingelheim Please note: 2016-ongoing by Reda Girgis, value=Honoraria Speaker/Speaker's Bureau relationship with Genentech Please note: 2016-ongoing by Reda Girgis, value=Honoraria No relevant relationships by Ryan Hadley No relevant relationships by Sheila Krishnan No relevant relationships by Lindsey LeQuia No relevant relationships by Edward Murphy No relevant relationships by Gayathri Sathiyamoorthy No relevant relationships by Ranuka Sinniah