Hyperbaric oxygen therapy to prevent central airway stenosis after lung transplantation

Bryan D. Kraft, Kamran Mahmood, Nicole P. Harlan, Matthew G. Hartwig, Laurie D. Snyder, Hagir B. Suliman, Scott L. Shofer

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

BACKGROUND: Central airway stenosis (CAS) is a severe airway complication after lung transplantation associated with bronchial ischemia and necrosis. We sought to determine whether hyperbaric oxygen therapy (HBOT), an established treatment for tissue ischemia, attenuates post-transplant bronchial injury. METHODS: We performed a randomized, controlled trial comparing usual care with HBOT (2 atm absolute for 2 hours × 20 sessions) in subjects with extensive airway necrosis 4 weeks after transplantation. Endobronchial biopsies were collected at 4, 7, and 10 weeks after transplantation for a quantitative polymerase chain reaction. Coprimary outcomes were incidence of airway stenting and acute cellular rejection (ACR) at 1 year. RESULTS: The trial was stopped after enrolling 20 subjects (n = 10 per group) after a pre-planned interim analysis showed no difference between usual care and HBOT groups in stenting (both 40%), ACR (70% and 40%, respectively), or CAS (40% and 60%, respectively). Time to first stent placement (median [interquartile range]) was significantly shorter in the HBOT group (150 [73–150] vs 186 [167–206] days, p < 0.05). HIF gene expression was significantly increased in donor tissues at 4, 7, and 10 weeks after transplantation but was not altered by HBOT. Subjects who developed CAS or required stenting had significantly higher HMOX1 and VEGFA expression at 4 weeks (both p < 0.05). Subjects who developed ACR had significant FLT1, TIE2, and KDR expression at 4 weeks (all p < 0.05). CONCLUSIONS: Incidence of CAS is high after severe, established airway necrosis after transplantation. HBOT does not reduce CAS severity or stenting. Elevated HMOX1 and VEGFA expressions appear to associate with airway complications.

Original languageEnglish
Pages (from-to)269-278
Number of pages10
JournalJournal of Heart and Lung Transplantation
Volume40
Issue number4
DOIs
StatePublished - Apr 2021

Keywords

  • cell hypoxia/genetics
  • gene expression
  • hyperbaric oxygenation
  • lung transplantation
  • post-operative complications

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