C60-04 Successful Management of Persistent Air Leak Using Endobronchial Valve Placement in a Pediatric Lung Transplant Recipient

Abstract A 15-year-old male with cystic fibrosis (3120 + 1GA/W496X, CFTR modulator therapy ineligible) complicated by pancreatic insufficiency, liver disease, cystic fibrosis-related diabetes, and end-stage lung disease underwent bilateral sequential lung transplantation. His post-transplant course was marked by multiple episodes of acute cellular rejection, development of chronic lung allograft dysfunction and newly diagnosed antibody-mediated rejection. At 19 months post-transplant, he underwent surveillance fluoroscopy-guided transbronchial biopsy of the right middle lobe following treatment for an episode of severe acute rejection. Pre-procedure spirometry revealed severe obstruction with forced vital capacity of 2.33L, z= -2.66, 66% predicted and forced expiratory volume in one second of 0.81L z= -5.24, 26% predicted. A post-procedure chest radiograph revealed bilateral pneumothorax, requiring bilateral thoracostomy tube placement (Figure 1A/B). His respiratory support was sequentially weaned to supplemental oxygen via low-flow nasal cannula. A computed tomography scan of the chest showed no bronchopleural fistulas. The left-sided air leak ceased spontaneously by post-operative day 14, but the right thoracostomy tube continued to demonstrate an intermittent air leak and recurrence of a pneumothorax with water-seal. Therefore, a flexible bronchoscopy was performed on post-operative day 14 to localize and address the right-sided air leak. Using a 5.8mm flexible bronchoscope through a 7.0 endotracheal tube, a 9mm endobronchial valve was placed in the right middle lobe bronchus (Figure 1C). Air leak cessation was confirmed. The patient tolerated the procedure without complications, and the thoracostomy tube was removed three days later. This case highlights the utility of endobronchial valve placement in managing persistent air leaks in pediatric lung transplant recipients, where post-transplant complications intersect with unique anatomic and physiologic challenges. This abstract is funded by: None