title: Incidence, management and clinical outcomes of patients with airway complications following lung transplantation.
abstract: 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.
authors.affiliation: Department of Thoracic Surgery and Lung Transplantation Unit, University Hospital Reina Sofía, Córdoba, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Moreno
authors.forename: Antonio
authors.initials: A
authors.lastname: Alvarez
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Algar
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Cano
authors.forename: Dionisio
authors.initials: D
authors.lastname: Espinosa
authors.forename: Francisco
authors.initials: F
authors.lastname: Cerezo
authors.forename: Carlos
authors.initials: C
authors.lastname: Baamonde
authors.forename: Angel
authors.initials: A
authors.lastname: Salvatierra
mesh_terms: 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