Depts of Pulmonary Medicine, Hanover Medical School, Hanover, Germany.
Eur Respir J. 2009 Dec;34(6):1417-22. doi: 10.1183/09031936.00041909. Epub 2009 May 14.
Airway complications affect 20% of all lung transplant recipients. Self-expandable metallic stents (SEMS) are one treatment option but their use in benign airway disorders is controversial. We studies the long-term safety of SEMS in lung transplant recipients. Between January 1998 and February 2008, all lung transplant recipients with SEMS were analysed retrospectively at a single centre. Complications were recorded until September 2008. In 65 (9.2%) out of 706 recipients, 111 (91% noncovered) bronchial SEMS were implanted a median (range) 133 (55-903) days after lung transplantation; follow-up was 777 (7-3.655) days. Clinical improvement was noted in 80% of recipients. The forced expiratory volume in 1 s increased by (mean+/-SD) 21+/-33%. Most frequent early complications were migration (3%) and mucus plugging (11%). No procedure-related deaths were noted. Re-stenosis occurred in 34 (52%) out of 65 recipients 85 (7-629) days after insertion. In multivariate analysis, stent insertion before post-operative day 90 was independently associated with an increased risk of re-stenosis (HR 3.29, 95% CI 1.50-7.18; p = 0.003). In 40% of recipients, new bacterial airway colonisation occurred after SEMS insertion. In SEMS patients, 5-yr survival was significantly lower than in the total cohort (60% versus 76%; p = 0.02). Late complications in lung transplant recipients treated with SEMS are frequent. The major problems are re-stenosis and airway colonisation.
气道并发症影响所有肺移植受者的 20%。自膨式金属支架（SEMS）是一种治疗选择，但它们在良性气道疾病中的应用存在争议。我们研究了 SEMS 在肺移植受者中的长期安全性。1998 年 1 月至 2008 年 2 月，在一家中心回顾性分析了所有接受 SEMS 的肺移植受者。记录并发症直至 2008 年 9 月。在 706 例受者中，65 例（9.2%）于肺移植后中位数（范围）133（55-903）天内植入 111 个（91%为未覆盖）支气管 SEMS；随访时间为 777（7-3.655）天。80%的受者临床症状改善。用力呼气量第 1 秒增加（均值+/-标准差）21+/-33%。最常见的早期并发症是迁移（3%）和黏液栓（11%）。无与操作相关的死亡。再狭窄发生于植入后 85（7-629）天的 34 例（52%）受者中。多变量分析显示，术后第 90 天前植入支架与再狭窄风险增加独立相关（HR 3.29，95%CI 1.50-7.18；p = 0.003）。在 40%的受者中，在 SEMS 植入后出现新的细菌气道定植。在 SEMS 患者中，5 年生存率明显低于总队列（60%比 76%；p = 0.02）。接受 SEMS 治疗的肺移植受者的晚期并发症较为常见。主要问题是再狭窄和气道定植。
