title: Impact of anastomotic airway complications after lung transplantation.
abstract: BACKGROUND
  Because improper airway healing continues as a source of morbidity after lung transplantation, we determined prevalence and risk factors for anastomotic complications and examined their impact on survival.
  
  
  METHODS
  From January 1997 to January 2004, 272 patients undergoing pulmonary transplantation were studied for anastomotic airway complications. Complications were categorized as necrosis or obstruction and treatment as none, endoscopic (stenting, bronchoplasty, ablation), or open repair. Survival impact was assessed by follow-up (mean, 3.0 +/- 2.2 years) using competing-risks nonproportional hazards methodology in the context of repeated events.
  
  
  RESULTS
  By 24 months, 94 anastomotic airway complications (26 necrotic, 67 obstructive, 1 torsion) had developed in 48 patients (18%), and 23 (8.5% overall; 48% of affected patients) underwent intervention. Risk of necrotic complications preceded obstruction. Risk factors were telescoping anastomosis (p < 0.0001), more recent transplant (p < 0.0001), donor-recipient size mismatch (p = 0.008), and previously treated anastomotic airway complication (p < 0.0001). Seventy-eight interventions were performed for 60 of the 94 complications. Compared with patients experiencing no anastomotic airway complications, those with treated complications had equivalent early survival (82% versus 80% at 12 months, p = 0.9) but worse late survival (60% versus 27% at 48 months, p = 0.03), and those with untreated complications had worse early survival (82% versus 62% at 12 months, p = 0.004) but equivalent late survival (p = 0.4).
  
  
  CONCLUSIONS
  Anastomotic airway complications occur in about one fifth of patients after lung transplantation and are formidable and persistent problems. Early complications are necrosis, followed by obstruction. Few risk factors are modifiable. Because these complications importantly affect survival, improving efficacy of intervention strategies should improve outcome.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA. murthys1@ccf.org
authors.forename: Sudish C
authors.initials: SC
authors.lastname: Murthy
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Gildea
authors.forename: Gonzalo V
authors.initials: GV
authors.lastname: Gonzalez-Stawinski
authors.forename: Jing
authors.initials: J
authors.lastname: Feng
authors.forename: Marie
authors.initials: M
authors.lastname: Budev
authors.forename: David P
authors.initials: DP
authors.lastname: Mason
authors.forename: Gösta B
authors.initials: GB
authors.lastname: Pettersson
authors.forename: Atul C
authors.initials: AC
authors.lastname: Mehta
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D015995:Prevalence; D012140:Respiratory Tract Diseases / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis