Last Updated: 2009-12-16 15:03:17 -0400 (Reuters Health)
NEW YORK (Reuters Health) - When airway obstruction after lung transplantation is corrected with self-expanding metal stents (SEMS), the risk of late complications is high, German researchers report in the December issue of the European Respiratory Journal.
"SEMS were effective in the short-term management of central airway obstruction after lung transplantation, but have a high complication rate in the long term," lead investigator Dr. Jens Gottlieb, from Hanover Medical School, told Reuters Health.
Dr. Gottlieb and colleagues reviewed their data on 706 lung recipients, 65 of whom (9.2%) received 111 SEMS at a median of 133 after the transplant. Most (72%) had placement within the first 6 months posttransplant. In all cases, the airway obstruction was refractory to other therapies.
Eighty percent of patients had relief of their clinical symptoms, and lung function (FEV1) increased by a mean of 21%, the authors report. The most common early complications were mucous plugging, which occurred in 7 patients (11%), and stent migration, which occurred in 2 patients (3%).
Eventually, over a median of 777 days (range, 7 to 3655), 34 patients (52%) developed re-stenosis at a median of 85 days after insertion. Forty percent of patients had new bacterial airway colonization after SEMS insertion.
Overall, 52 patients (80%) had stent-related complications.
Five-year survival was significantly lower in the SEMS group than in complete cohort of 706 patients (60% versus 76%).
The findings, continued Dr. Gottlieb, are "of special concern in other benign airway diseases. In contrast to malignant central airway obstruction, indication of SEMS placement in benign disorders should be critically discussed."
"Other therapies," he concluded, "should be considered prior to the placement of a SEMS. Topical administration of drugs and removable or biodegradable stents may play a future role in this situation."
Eur Respir J 2009;34:1417-1422.
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