title: Anastomotic airway complications after lung transplantation: risk factors, treatment modalities and outcome-a single-centre experience.
abstract: OBJECTIVE
  Anastomotic airway complications give rise to morbidity and mortality after lung transplantation. Knowledge about contributing factors helps in adopting diagnostic and therapeutic strategies. Systematic endoscopic description and classification play a key role.
  
  
  METHODS
  A retrospective analysis of all bronchial anastomoses between 2005 and 2013 was performed to assess anastomotic complications and associated variables. Treatment modalities and outcome of endobronchial and surgical interventions are reported.
  
  
  RESULTS
  The prevalence of anastomotic airway complications in our cohort was 11%. Contributive factors were all recipient-dependent: microbial infection during the first postoperative trimester [odds ratio (OR) 3.4 (2.1-5.5); P < 0.0001], recipient age [OR 3.0 (1.3-7.1); P = 0.01], right-sided anastomosis [OR 2.5 (1.4-3.3); P = 0.001], the presence of microbiological colonization prior to transplantation [OR 1.8 (1.1-3.1); P = 0.02] and [Formula: see text] during the first 72 h after transplantation [OR 1.6 (1.1-2.7); P = 0.04]. Seventy-five percent of cases were managed conservatively, of which 93% evolved clinically favourable during follow-up. Our data support the use of the proposed MDS classification and show that MDS class M3b, D2x, Sxe or higher are associated with an increased intervention rate.
  
  
  CONCLUSIONS
  Anastomotic airway complications remain an important issue after lung transplantation. The identified risk factors may play a role in the pathophysiology of anastomotic complications. The indication for endobronchial intervention should be carefully considered based on endoscopic classification since most cases resolve or stabilize over time.
authors.affiliation: Department of Respiratory Diseases, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium jonas.yserbyt@uzleuven.be.
authors.forename: Jonas
authors.initials: J
authors.lastname: Yserbyt
authors.affiliation: Department of Respiratory Diseases, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Dooms
authors.affiliation: Department of Respiratory Diseases, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Robin
authors.initials: R
authors.lastname: Vos
authors.affiliation: Department of Respiratory Diseases, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Lieven J
authors.initials: LJ
authors.lastname: Dupont
authors.affiliation: Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Dirk E
authors.initials: DE
authors.lastname: Van Raemdonck
authors.affiliation: Department of Respiratory Diseases, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Geert M
authors.initials: GM
authors.lastname: Verleden
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000401:mortality / Q000503:physiopathology; D001530:Belgium; D001980:Bronchi / Q000601:surgery; D001982:Bronchial Diseases / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001986:Bronchial Spasm / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D001999:Bronchoscopy / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D016040:Lung Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015995:Prevalence; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Airway stent; Anastomosis; Bronchoscopy; Lung transplantation