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Airway complications after lung transplantation: benefit of a conservative bronchoscopy strategy
BACKGROUND: After lung transplantation (LT), between 2% and 25% of bronchial anastomoses develop complications requiring therapeutic intervention. The status of healing of both bronchial anastomoses and downhill airways are well described by the French consensual MDS standardized grading system (Mac...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330399/ https://www.ncbi.nlm.nih.gov/pubmed/32642170 http://dx.doi.org/10.21037/jtd.2020.03.21 |
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author | Patoir, Arnaud Luchez, Antoine Tiffet, Olivier Vercherin, Paul Grima, Renaud Tronc, François Philit, François Mornex, Jean-François Vergnon, Jean-Michel Maury, Jean-Michel |
author_facet | Patoir, Arnaud Luchez, Antoine Tiffet, Olivier Vercherin, Paul Grima, Renaud Tronc, François Philit, François Mornex, Jean-François Vergnon, Jean-Michel Maury, Jean-Michel |
author_sort | Patoir, Arnaud |
collection | PubMed |
description | BACKGROUND: After lung transplantation (LT), between 2% and 25% of bronchial anastomoses develop complications requiring therapeutic intervention. The status of healing of both bronchial anastomoses and downhill airways are well described by the French consensual MDS standardized grading system (Macroscopic, Diameter, Suture). We analyzed risks factors for airway complications (AC) after transplantation and the way we managed them. We report here our challenging method of early rigid bronchoscopic intervention with airway stenting on bronchial healing. METHODS: All single center consecutives LTs were retrospectively analyzed between 2010–2016. Patient-level data (demographic, peri-operative data) and anastomosis-level data (surgical parameters, bronchoscopy findings) were monitored. The incidence and contributive factors of ACs are reported. We also reported modalities of the conservative treatment and outcome. RESULTS: A total of 121 LTs were performed, 39 single-lung and 82 bilateral sequential LT. Main indication for LT were cystic fibrosis (45%) and emphysema (25%) and 58 were male patients (n=70). After a waiting period of healing, 28 patients presented AC on 41 anastomoses (prevalence: 23%). A multivariate analysis found as contributive factors of ACs, post-operative infection by Aspergillus [odds ratio (OR) 2.7, 95% confidence interval (CI): 1.08–6.75; P=0.033] at the patient level, and at the anastomosis level, emphysema (OR 2.4, 95% CI: 1.02–5.6; P=0.045), early dehiscence (OR 11.2, 95% CI: 1.7–76; P=0.01) and cold ischemia time >264 min (OR 2.45, 95% CI: 1.08–5.6; P=0.03). All the 41 ACs were managed conservatively with rigid bronchoscopy (range, 1–10), 41 stents (21 in silicone and 20 fully-covered Silicone Expandable Metallic Stents) without major complication. Two AC were still under regular bronchoscopic care and silicone stenting for long left bronchus reason. No surgical intervention was needed. The 2-years overall survival rate where not different between AC group and controls, respectively 85% and 81%. CONCLUSIONS: Airway healing after transplantation remains a scalable process and the French consensual MDS classification helped us for therapeutic decisions. Rigid bronchoscopy and safety use of current stenting devices may have the pivotal role in the conservative management of ACs, avoiding perilous situation of surgery for AC. Despite a high rate of AC, their favorable evolution may be explained by the cautious care of airway healing and maybe by the use of the Celsior antioxidant solution. |
format | Online Article Text |
id | pubmed-7330399 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-73303992020-07-07 Airway complications after lung transplantation: benefit of a conservative bronchoscopy strategy Patoir, Arnaud Luchez, Antoine Tiffet, Olivier Vercherin, Paul Grima, Renaud Tronc, François Philit, François Mornex, Jean-François Vergnon, Jean-Michel Maury, Jean-Michel J Thorac Dis Original Article BACKGROUND: After lung transplantation (LT), between 2% and 25% of bronchial anastomoses develop complications requiring therapeutic intervention. The status of healing of both bronchial anastomoses and downhill airways are well described by the French consensual MDS standardized grading system (Macroscopic, Diameter, Suture). We analyzed risks factors for airway complications (AC) after transplantation and the way we managed them. We report here our challenging method of early rigid bronchoscopic intervention with airway stenting on bronchial healing. METHODS: All single center consecutives LTs were retrospectively analyzed between 2010–2016. Patient-level data (demographic, peri-operative data) and anastomosis-level data (surgical parameters, bronchoscopy findings) were monitored. The incidence and contributive factors of ACs are reported. We also reported modalities of the conservative treatment and outcome. RESULTS: A total of 121 LTs were performed, 39 single-lung and 82 bilateral sequential LT. Main indication for LT were cystic fibrosis (45%) and emphysema (25%) and 58 were male patients (n=70). After a waiting period of healing, 28 patients presented AC on 41 anastomoses (prevalence: 23%). A multivariate analysis found as contributive factors of ACs, post-operative infection by Aspergillus [odds ratio (OR) 2.7, 95% confidence interval (CI): 1.08–6.75; P=0.033] at the patient level, and at the anastomosis level, emphysema (OR 2.4, 95% CI: 1.02–5.6; P=0.045), early dehiscence (OR 11.2, 95% CI: 1.7–76; P=0.01) and cold ischemia time >264 min (OR 2.45, 95% CI: 1.08–5.6; P=0.03). All the 41 ACs were managed conservatively with rigid bronchoscopy (range, 1–10), 41 stents (21 in silicone and 20 fully-covered Silicone Expandable Metallic Stents) without major complication. Two AC were still under regular bronchoscopic care and silicone stenting for long left bronchus reason. No surgical intervention was needed. The 2-years overall survival rate where not different between AC group and controls, respectively 85% and 81%. CONCLUSIONS: Airway healing after transplantation remains a scalable process and the French consensual MDS classification helped us for therapeutic decisions. Rigid bronchoscopy and safety use of current stenting devices may have the pivotal role in the conservative management of ACs, avoiding perilous situation of surgery for AC. Despite a high rate of AC, their favorable evolution may be explained by the cautious care of airway healing and maybe by the use of the Celsior antioxidant solution. AME Publishing Company 2020-05 /pmc/articles/PMC7330399/ /pubmed/32642170 http://dx.doi.org/10.21037/jtd.2020.03.21 Text en 2020 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Original Article Patoir, Arnaud Luchez, Antoine Tiffet, Olivier Vercherin, Paul Grima, Renaud Tronc, François Philit, François Mornex, Jean-François Vergnon, Jean-Michel Maury, Jean-Michel Airway complications after lung transplantation: benefit of a conservative bronchoscopy strategy |
title | Airway complications after lung transplantation: benefit of a conservative bronchoscopy strategy |
title_full | Airway complications after lung transplantation: benefit of a conservative bronchoscopy strategy |
title_fullStr | Airway complications after lung transplantation: benefit of a conservative bronchoscopy strategy |
title_full_unstemmed | Airway complications after lung transplantation: benefit of a conservative bronchoscopy strategy |
title_short | Airway complications after lung transplantation: benefit of a conservative bronchoscopy strategy |
title_sort | airway complications after lung transplantation: benefit of a conservative bronchoscopy strategy |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330399/ https://www.ncbi.nlm.nih.gov/pubmed/32642170 http://dx.doi.org/10.21037/jtd.2020.03.21 |
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