Endoscopic indicators for obstructive airway complications after lung transplantation.
BACKGROUND
Obstructive airway complications (OACs) are a significant cause of morbidity after lung transplantation (LTx). Endoscopic evaluation early after LTx may help earlier identification of patients at risk.


METHODS
Anastomotic healing process was prospectively evaluated in 169 LTx recipients by bronchoscopy between 2007 and 2009 in a single center. Bronchoscopies were performed on day 7, 14, 21, 90, 180, and 360 after LTx. A scoring system of airway healing was constructed.


RESULTS
In 42 of 169 patients (25%), OAC occurred. Dehiscence (P≤0.001), extensive necrosis (P=0.001), fibrinous plug (P≤0.001), and mucosal healing at segmental level (P=0.001) on day 21 after LTx were significantly associated with later occurrence of OAC. The hereby developed Mucosal Airway Score for Healing (0-8 points, cutoff >3 points) proved to predict later OAC in 67 patients of validation phase (sensitivity=0.97; specificity=0.93; positive predictive value=0.85; and negative predictive value=0.96). Substantial interobserver agreement using Mucosal Airway Score for Healing was achieved (κ=0.617). All airway complications were managed with endoscopic intervention, and no surgical treatment was necessary.


CONCLUSIONS
Endoscopic appearance on day 21 after LTx predicts later occurrence of OAC. The resulting scoring system may be used in the early postoperative period as a tool to assess preventive strategies.
Fuehner
Thomas
T
Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany. fuehner.thomas@mh-hannover.de
Dierich
Martin
M
Duesberg
Christoph
C
Wiesner
Olaf
O
Warnecke
Gregor
G
Welte
Tobias
T
Simon
Andre R
AR
Gottlieb
Jens
J
D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D001999:Bronchoscopy; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D005858:Germany; D016041:Heart-Lung Transplantation / Q000009:adverse effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D015588:Observer Variation; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015203:Reproducibility of Results; D020545:Respiratory Mucosa / Q000293:injuries* / Q000473:pathology; D018570:Risk Assessment; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing