SILICONE AIRWAY STENTS FOR LUNG TRANSPLANT ANASTOMOTIC DEHISCENCE

SESSION TITLE: Wednesday Electronic Posters 3 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Post-Transplant airway dehiscence is a rare but serious complication after lung transplantation. Bare metal self-expanding stents have been used for bronchoscopic treatment of anastomotic dehiscence to promote granulation tissue formation, leading to healing, and closure of the dehiscence. However, excessive granulation tissue formation can cause airway obstruction requiring therapeutic procedures to maintain airway patency. In addition, bare metal stents can become epithelialized within the airway making their removal difficult, increasing the risk of significant airway injury. To avoid this complication, bare metal stents are often replaced at 2-week intervals until complete resolution of the dehiscence is achieved. We propose that silicone stents can offer a safe treatment alternative for lung transplant anastomotic dehiscence. METHODS: We performed a retrospective review of our patients who underwent airway stent placement for anastomotic dehiscence between January 1, 2004 and January 17, 2019. Patient characteristics and outcomes were recorded. RESULTS: One hundred and one transplant patients underwent therapeutic bronchoscopy with stent placement for airway complications over the study period. Ten patients from this cohort had clinically significant anastomotic dehiscence as determined by the transplant and interventional pulmonary teams. The median time from transplantation to dehiscence diagnosis was 31 days (IQR 30 days), and the median time from dehiscence diagnosis to stent placement was 5.8 days (IQR 7 days). Eight silicone (Novatech Dumon stents, Boston Medical Products, Inc., MA., USA) and 2 bare metal self-expanding stents (Ultraflex, Boston Scientific, MA, USA) were placed. All the silicone stents were placed with rigid bronchoscopy. The bare metal stents were placed through a rigid bronchoscope under direct visualization with a flexible bronchoscope. The silicone stents were removed after a median of 42 days (IQR 29 days). No immediate complications were seen. The long-term complications of silicone stents were stent migration in two patients; one patient required stent repositioning, the other had their stent removed as the dehiscence had healed. In the two patients treated with bare metal stents, one had a stent migration which was removed and replaced with a silicone stent, and the other had obstructive granulation tissue formation requiring debridement at day 20. CONCLUSIONS: Silicone stents are a safe and effective way to manage lung transplant anastomotic dehiscence. CLINICAL IMPLICATIONS: Silicone stents should be considered as a safe alternative to bare metal stents for lung transplant dehiscence. These stents can be easily removed within a few weeks which may decrease the number of procedures necessary for management of the dehiscence and reduce the risk of long-term stent complications. DISCLOSURES: Owner/Founder relationship with Restore3D Please note: $5001 - $20000 Added 11/27/2018 by George Cheng, source=Web Response, value=Ownership interest Consultant relationship with Medtronic Please note: $1-$1000 Added 11/27/2018 by George Cheng, source=Web Response, value=Consulting fee Research relationship with Intuitive Surgical Please note: $20001 - $100000 Added 11/27/2018 by George Cheng, source=Web Response, value=Grant/Research Consultant relationship with Boston Scientific Please note: $1001 - $5000 Added 11/27/2018 by George Cheng, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Pinnacle Biologics Please note: $1-$1000 Added 11/27/2018 by George Cheng, source=Web Response, value=Honoraria Research relationship with Veran Please note: $1001 - $5000 Added 11/27/2018 by George Cheng, source=Web Response, value=Grant/Research Support No relevant relationships by Coral Giovacchini, source=Web Response No relevant relationships by Kamran Mahmood, source=Web Response No relevant relationships by Luke Seaburg, source=Web Response no disclosure on file for Scott Shofer; No relevant relationships by Momen Wahidi, source=Web Response