Incidence, management and clinical outcomes of patients with airway complications following lung transplantation.
OBJECTIVE
Airway complications (AC) remain a significant contributing factor of morbidity after lung transplantation (LT). The aim of this study was to identify risk factors for AC, and to review the outcomes after endoscopic and surgical treatment.


METHODS
From 1993 to 2006, 255 patients underwent LT. Seven retransplants and 34 patients not surviving beyond 7 days were excluded. The remaining patients were: 124 double LT (DLT), 85 single LT (SLT), 3 lobar LT and 2 liver-DLT, comprising 343 bronchial anastomoses at risk. Donor lungs were flushed with either modified Eurocollins or Perfadex. Bronchial anastomoses were telescoped when needed. Donor and recipient variables were recorded and analyzed by univariate and multivariate tests to identify risk factors for AC, and to assess differences between both complicated and non-complicated groups.


RESULTS
Among 343 bronchial anastomoses, 31 presented AC (9%) in 27 patients (12.6%): 22 stenoses, 5 dehiscences, and 4 malacias, at 2.6+/-1.7 months post-transplant. Indications were 7 emphysema, 3 Alpha-1-antitrypsin deficiency, 12 cystic fibrosis (p=0.007), 4 pulmonary fibrosis, and 1 bronchiectasis. AC were observed in 4 SLT and 23 DLT (p=0.005). Incidence of AC did not differ between telescoped and non-telescoped anastomoses. By univariate analysis, AC were more frequent in grafts preserved with modified Eurocollins (p=0.033), CMV infection/disease (p=0.027) and airway colonizations post-transplant (p=0.021). Other donor and recipient variables did not differ between groups. By multivariate analysis, intubation longer than 72 h, DLT, and airway colonizations post-transplant remained independently associated with AC. Survival did not differ between groups. Most patients were successfully treated with endoscopic procedures; three required reoperation (lobectomy, pneumonectomy, retransplantation). AC related mortality was 1%.


CONCLUSIONS
The incidence of AC after LT is 12.6% with a related mortality of 1%, irrespective of the technique of bronchial anastomosis performed. DLT, airway colonizations, and prolonged intubation post-transplant are associated with AC. Either endoscopic procedures or surgical therapy resolve these complications in most cases.
Moreno
Paula
P
Department of Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofía, Córdoba, Spain.
Alvarez
Antonio
A
Algar
Francisco Javier
FJ
Cano
José Ramón
JR
Espinosa
Dionisio
D
Cerezo
Francisco
F
Baamonde
Carlos
C
Salvatierra
Angel
A
D000328:Adult; D000714:Anastomosis, Surgical; D001980:Bronchi / Q000473:pathology / Q000601:surgery; D001982:Bronchial Diseases / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D001999:Bronchoscopy; D003251:Constriction, Pathologic; D005260:Female; D006084:Graft Rejection; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D016040:Lung Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D008297:Male; D009926:Organ Preservation; D011183:Postoperative Complications; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome