Single stage pediatric airway reconstruction in solid organ transplant recipients

Abstract

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.

Keywords: Airway; Airway reconstruction; Cardiac; Children; Dysphagia; Heart; Kidney; Laryngotracheoplasty; Larynx; Obstruction; Pediatric; Renal; Stridor; Swallowing; Tracheostomy; Transplant.