Angioplasty using covered stents in five patients with symptomatic pulmonary artery stenosis after single-lung transplantation

Objective: After lung transplantation, pulmonary artery stenosis (PAS) may occur at the anastomotic site, resulting in poor graft function and hypoxemia. Surgical repair has been the standard-of-care, although percutaneous angioplasty with stent insertion has been performed in patients unsuitable for surgery. We summarize our experience of pulmonary artery stent-graft placement in transplant recipients who were also fit for surgical repair. Materials and Methods: Retrospective review of five cases of single-lung transplant recipients (4 male, 1 female, median age 61 years) who underwent percutaneous angioplasty and insertion of stent-graft for severe PAS. Balloon-expandable stent-grafts were used that were tailored to the donor and recipient vessel diameters. Results: Stenosis was diagnosed with computed tomography angiography at a median of 44 days (range 22-84) after transplantation. All stent placements were technically successful. There was only one periprocedural complication, a haemothorax that was drained. In four patients, the angioplasty improved the lung function; relative graft perfusion (as assessed by quantitative lung scintigraphy) improved by 26 % (IQR 13-37); and SpO₂ improved by 8 % (IQR 4-9). Conclusion: Percutaneous angioplasty using stent-graft is a minimally invasive, safe, and efficacious procedure for treatment of posttransplantation PAS and should be considered as an alternative to surgery even when the patient is considered fit for surgical repair.