Clinical Experience With a New Removable Tracheobronchial Stent in the Management of Airway Complications After Lung Transplantation Sebastian Fernandez-Bussy, MD, Olufemi Akindipe, MD, Varsha Kulkarni, MD, Wendy Swafford, ARNP, Maher Baz, MD, and Michael A. Jantz, MD Background: Airway complications are among the most challenging problems after lung transplantation. This article describes the use of a new tracheobronchial stent that can be placed and removed easily by flexible bronchoscopy. Methods: A retrospective review was done of 24 consecutive patients requiring tracheobronchial stent placement after lung transplantation. A new self-expanding hybrid nitinol stent was used, and changes in airway diameter and spirometry were assessed. Stent related complications were recorded. Results: Between February 2007 and April 2008, 24 patients underwent stent placement, and 49 stents were placed for 36 anastomoses at risk. Indications included bronchial stenosis in 12, bronchomalacia in 12, bronchial stenosis plus bronchomalacia in 20, and partial bronchial dehiscence in 5. Adjunctive procedures included electrocautery in 1, balloon dilatation in 7, and electrocautery plus balloon dilatation in 4. The average degree of stenosis decreased from 80% to 20%. After stent placement, the average increase was 0.28 liters in forced vital capacity and 0.44 liters in forced expiratory volume in 1 second. Complications included granulation tissue formation in 10 stents, migration in 9, thick mucus formation in 2, and fracture in 3. Conclusion: Airway complications in lung transplant patients were effectively palliated. Our complication rate with this new stent is comparable with other airway stents. This stent has the advantage of easy removability during flexible bronchoscopy if complications from the stent outweigh the benefits of palliation. J Heart Lung Transplant 2009;28:683– 8. Copyright © 2009 by the International Society for Heart and Lung Transplantation. Airway complications after lung transplantation have been reported to occur in up to 27% of patients. 1–11 A review of our institutional experience indicates that 24% of our lung transplant recipients have airway complications. These complications have been attrib- uted to a lack of blood flow to the donor tracheobron- chial tree that invariably occurs during the first few days after surgery. The bronchial artery circulation is usually not reestablished during transplantation, and revascu- larization from the recipient pulmonary artery plexus takes 1 to 2 weeks. 12 Thus, donor bronchus viability is initially dependent on retrograde collaterals from the pulmonary artery. 13 Surgical revascularization of the transplant bronchial arteries is thought to be a technically demanding and complicated procedure and is not commonly per- formed. 14,15 Other techniques such as shortening the donor bronchial stump, 16 reinforcing the anastomosis with a vascularized tissue pedicle such as omentum 17 or intercostal muscle, 18 and intussuscepting bronchial anastomotic techniques 19,20 have been used to mini- mize bronchial anastomotic complications. Acute rejec- tion, immunosuppression, infections, and inadequate organ preservation may also contribute to compro- mised airway healing. 1,3,4,21 Complications such as bronchial stenosis (fixed ana- tomic obstruction due to formation of exuberant fi- brotic tissue), bronchomalacia (dynamic obstruction on exhalation), or bronchial dehiscence can lead to bicon- cave changes of the flow-volume loop, 22,23 dyspnea, wheezing, declining lung function, and post-obstructive From the Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida Health Science Center, Gainesville, Florida. Submitted January 5, 2009; revised March 13, 2009; accepted April 9, 2009. Dr Jantz has received honorarium from Alveolus Inc and has served on the Alveolus Inc Medical Advisory Board since approximately year 2000. He has received $600 annually for this service from 2000 to 2006. This conflict of interest was reported to our local IRB for this project. Reprint requests: Sebastian Fernandez-Bussy, MD, Division of Pul- monary, Critical Care and Sleep Medicine, University of Florida Health Sciences Center, PO Box 100225 Gainesville, FL 32610. Telephone: 352-265-8940. Fax: 352-265-8970. E-mail: bussysf@medicine.ufl.edu Copyright © 2009 by the International Society for Heart and Lung Transplantation. 1053-2498/09/$–see front matter. doi:10.1016/ j.healun.2009.04.014 683