Airway complications after lung transplantation: Contemporary survival and outcomes.
Airway complications are rare and cause increased morbidity and mortality after lung transplantation (LT). We sought to examine risk factors associated with this complication and its impact on survival.



We retrospectively evaluated United Network for Organ Sharing data from 2000 to 2012. A backward stepwise logistic regression was performed on recipient-, donor-, and transplant-related variables to select independent risk factors associated with airway complications and mortality. Survival was evaluated using the Kaplan-Meier method.



We evaluated 16,156 consecutive adult LT recipients, among whom 233 (1.4%) developed airway complications. Predictors of increased risk of airway complications included male gender (odds ratio [OR] 1.61, p = 0.001), advancing recipient age (OR 1.02, p < 0.001) and pre-transplantation admission to the intensive care unit (ICU) (OR 2.13, p < 0.001). The 30-day (89.6% vs 96.2%, p = 0.001), 90-day (69.9% vs 93.1%, p < 0.001), 1-year (54.6% vs 84.4%, p < 0.001), 3-year (38.7% vs 67.4%, p < 0.001) and 5-year (33.2% vs 54.2%, p < 0.001) survival rates were each significantly reduced in recipients with airway complications. Factors associated with an increased risk of 1-year mortality included recipient age (hazard ratio [HR] 1.01, p < 0.001), use of extracorporeal mechanical support (HR 1.5, p = 0.01), diagnosis of cystic fibrosis (HR 1.22, p = 0.01), glomerular filtration rate (GFR) 60 to 90 ml/min/1.73 m2(HR 1.61, p < 0.001), GFR <60 ml/min/1.73 m2(HR 1.13, p = 0.01), non-ICU hospitalization (HR 1.32, p < 0.001), pre-transplantation ICU hospitalization (HR 2.54, p < 0.001), donor with positive serology for cytomegalovirus (HR 1.16, p < 0.001) and donor with a smoking history (HR 1.19, p < 0.001). Double LT (HR 0.83, p < 0.001) was associated with a decreased risk of death. Chronic obstructive pulmonary disease/emphysema was protective compared with idiopathic pulmonary fibrosis (HR 0.85, p = 0.008).



Airway complications are associated with a significant mortality burden.
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Electronic address: jhayanga@me.com.
J W
JW
Awori Hayanga
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Jonathan K
JK
Aboagye
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Norihisa
N
Shigemura
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Heather K
HK
Hayanga
DeVos Heart & Lung Transplantation Program, Spectrum Health System, Grand Rapids, Michigan, USA.
Edward
E
Murphy
DeVos Heart & Lung Transplantation Program, Spectrum Health System, Grand Rapids, Michigan, USA.
Asghar
A
Khaghani
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Jonathan
J
D'Cunha
D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis; D016040:Lung Transplantation; D008297:Male; D011656:Pulmonary Emphysema; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors
airway complications; contemporary; lung allocation score; lung transplantation; outcomes; predictors; survival