Safety of hybrid bronchial stents in transplant airway complications: a single center experience

BACKGROUND: Tracheobronchial stents are often used to manage lung transplant airway complications. In 2005, the Food and Drug Administration (FDA) issued a warning against the use of metallic stents for benign airway disease. Since that time, fully covered hybrid metallic stents have been developed and are increasingly used due to their ease of insertion and removal. There is limited data to support their safe utilization for transplant airway complications. This is the largest analysis to date of the safety of hybrid metallic stents for transplant airway complications. METHODS: We performed a retrospective study of patients who had covered metallic stents placed for transplant airway complications between April 2016 to April 2021. Information obtained from chart review included demographics, procedure notes and stent data including indication for placement, type, size, location, duration, and complications. RESULTS: We identified 50 patients who had a combined 376 stents placed for a total of 15,711 stent days. The most common minor complication and reason for removal was mucus plugging affecting 193 stents.There were only two cases of major stent associated complications. Among minor complications, there was a increased risk of stent fracture with Bonastent(®) (P=0.04). CONCLUSIONS: Our data shows that hybrid metallic stents are a safe intervention for patients with transplant airway complications. Most complications were minor and managed with repeat bronchoscopy. There were only two major complications over a 5-year period. Given the wide spectrum of possible airway complications, further research is needed to determine the optimal use of stents for patients with transplant airway complications.