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Published on: July 10, 2012
Single stage pediatric airway reconstruction in solid organ transplant recipients
Emily Belding1, Sohit Paul Kanotra2
1University of Iowa Hospitals and Clinics, Department of Otolaryngology- Head and Neck Surgery, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
Insights
Single stage laryngotracheal reconstruction (ssLTR) is a viable option for solid organ transplant recipients with subglottic stenosis. These patients require multidisciplinary care and adjusted medication protocols.
Area of Science:
- Pediatric Otolaryngology
- Transplant Surgery
- Airway Reconstruction
Background:
- Solid organ transplant recipients can develop subglottic stenosis.
- Management of airway issues in transplant patients requires careful consideration of immunosuppression and potential drug toxicities.
Purpose of the Study:
- To evaluate the outcomes of single stage laryngotracheal reconstruction (ssLTR) in pediatric patients with prior solid organ transplants.
- To identify necessary pre-operative, intra-operative, and post-operative modifications for this patient subset.
Main Methods:
- Retrospective case series review of pediatric patients undergoing ssLTR after solid organ transplantation.
- Analysis of demographic data, operative details, and clinical outcomes.
- Tertiary care academic setting.
Main Results:
- Two cases of ssLTR in renal and cardiac transplant patients with Grade 2 subglottic stenosis were successfully managed.
- Multidisciplinary care involved modified prophylactic antibiotics and adjusted immunosuppressant doses.
- Avoidance of nephrotoxic and cardiotoxic medications was critical.
Conclusions:
- Single stage laryngotracheal reconstruction is a feasible surgical option for solid organ transplant recipients.
- These complex cases necessitate a multidisciplinary approach and tailored pharmacological management throughout the peri-operative period.
Objectives:
To describe results of single stage laryngotracheal reconstruction (ssLTR) in patients with solid organ transplants and to discuss modifications which need to be considered in this subset of patients pre-operatively, intra-operatively and post-operatively.
Study Design:
We performed a retrospective case series review of children undergoing single stage laryngotracheal reconstruction in the context of prior solid organ transplant.
Setting:
A tertiary care academic setting.
Methods:
Pediatric cases undergoing Laryngotracheal reconstruction over a 3-year period. Demographic data including age, sex, presenting symptoms, operative details.
Results:
Two cases of ssLTR in solid organ transplant patients were found, one each with renal and cardiac transplants respectively. Both patients successfully underwent ssLTR for Grade 2 subglottic stenosis. The care of these patients was multidisciplinary and required alterations in their preoperative prophylactic antibiotics. While they did not require changes to the LTR post-operative sedation protocol, their immunosuppressant doses and target ranges were lowered. Special care was taken to avoid nephrotoxic and cardiotoxic medications throughout their hospital stay.
Conclusions:
Although traditionally considered for double stage laryngotracheal reconstruction, single stage laryngotracheal reconstruction is a viable option in patients with solid organ transplant. These patients require a multidisciplinary approach and pharmacological protocol alterations pre-, intra-, and post-operatively.
