title: Impact of anastomotic techniques on airway complications after lung transplant.
abstract: BACKGROUND
  Airway complications are a source of morbidity and expense after lung transplant. Posttransplant stenosis can occur when the donor bronchus is rendered ischemic and is dependent upon collateral flow from the pulmonary capillary system. By shortening the donor bronchus, the tissue at risk for ischemia is reduced. In an effort to reduce airway complications, one surgeon at our institution began dividing the donor bronchus at the lobar carina.
  
  
  METHODS
  This is a retrospective analysis of all transplanted patients over the 2-year period before and after the institution of the technique change. To adjust for covariates, we performed a propensity score analysis. Outcome endpoints were postoperative airway complications, specifically, the need for therapeutic bronchoscopy, dilation, stenting, or retransplant.
  
  
  RESULTS
  After instituting the practice of dividing the bronchus at the lobar carina, the incidence of airway complication for the principle surgeon decreased from 13.2% (7 of 53) to 2.1% (1 of 48), resulting in an improved freedom from airway complication for that surgeon. Compared with all transplants performed during this period, the modified anastomosis resulted in fewer airway complications: 2.1% (1 of 48) versus 8.2% (19 of 231). The propensity analysis matched the 48 patients who received the modified anastomosis with 48 patients who received the standard two ring length anastomosis by surgical colleagues. The modified anastomosis group had fewer required interventions for airway complications and had significantly better freedom from airway complication when followed over time.
  
  
  CONCLUSIONS
  Decreasing the amount of potentially ischemic tissue implanted from the donor bronchus can reduce posttransplant airway complications.
authors: Division of Cardiothoracic Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA.
authors: Victor
authors: V
authors: van Berkel
authors: Tracey J
authors: TJ
authors: Guthrie
authors: Varun
authors: V
authors: Puri
authors: Alexander S
authors: AS
authors: Krupnick
authors: Daniel
authors: D
authors: Kreisel
authors: G Alexander
authors: GA
authors: Patterson
authors: Bryan F
authors: BF
authors: Meyers
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000517:prevention & control*; D000714:Anastomosis, Surgical / Q000379:methods*; D001980:Bronchi / Q000601:surgery*; D001982:Bronchial Diseases / Q000517:prevention & control*; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome