Bronchial complications after lung transplantation are associated with primary lung graft dysfunction and surgical technique.
BACKGROUND
After lung transplantation, bronchial complications are one of the major concerns for surgeons and physicians. In the era of evolving immunosuppressive regimens and surgical approaches, we have reassessed risk factors for bronchial complications after lung transplantation.


METHODS
We undertook a retrospective study of all consecutive lung transplantations performed at a single center from 2004 to 2014. We monitored the incidence of symptomatic bronchial complications. Demographic data of donors and recipients were also studied. Our objective was to evaluate the impact of 3 subsequent immunosuppressive regimens (including the use of induction therapy), and of a technical modification of bronchial anastomosis on the incidence of airway complications.


RESULTS
We performed 270 consecutive lung transplantations during the study period. On multivariate analysis, bronchial complications were not directly associated with the different immunosuppressive regimens. In subgroup analysis, when comparing different immunosuppressive regimens, primary graft dysfunction within 72 hours (odds ratio [OR] = 2.55; p = 0.08), lung infection within the first month (OR = 2.96; p = 0.039), diabetes before transplantation (OR = 2.66; p = 0.11) and chronic obstructive pulmonary disease (OR = 2.20; p = 0.04) appeared as major risk factors (c-index = 0.77 on multivariate analysis). The use of a modified bronchial suture technique was associated with fewer bronchial complications (OR = 0.47; p = 0.059) (c-index = 0.71 on multivariate analysis).


CONCLUSIONS
The mode of immunosuppression had no influence on airway complications. We were able to reproduce the beneficial effect of a modified suture technique.
Lung Transplantation Group, Thoracic Surgery Department, University Hospital Strasbourg, Strasbourg, France; EA 7293 "Stress Vasculaire et Tissulaire en Transplantation," Translational Medecine Federation Strasbourg, University of Strasbourg, Strasbourg, France. Electronic address: anne.olland@chru-strasbourg.fr.
Anne
A
Olland
Lung Transplantation Group, Thoracic Surgery Department, University Hospital Strasbourg, Strasbourg, France; EA 7293 "Stress Vasculaire et Tissulaire en Transplantation," Translational Medecine Federation Strasbourg, University of Strasbourg, Strasbourg, France.
Jérémie
J
Reeb
Clinical Methodology Center, University Hospital Besançon, Besançon, France.
Marc
M
Puyraveau
Lung Transplantation Group, Thoracic Surgery Department, University Hospital Strasbourg, Strasbourg, France.
Sandrine
S
Hirschi
Lung Transplantation Group, Thoracic Surgery Department, University Hospital Strasbourg, Strasbourg, France.
Joseph
J
Seitlinger
Lung Transplantation Group, Thoracic Surgery Department, University Hospital Strasbourg, Strasbourg, France.
Nicola
N
Santelmo
Intensive Care and Anesthesiology Department, University Hospital Strasbourg, Strasbourg, France.
Olivier
O
Collange
Intensive Care and Anesthesiology Department, University Hospital Strasbourg, Strasbourg, France.
Paul-Michel
PM
Mertes
Lung Transplantation Group, Thoracic Surgery Department, University Hospital Strasbourg, Strasbourg, France; EA 7293 "Stress Vasculaire et Tissulaire en Transplantation," Translational Medecine Federation Strasbourg, University of Strasbourg, Strasbourg, France.
Romain
R
Kessler
Lung Transplantation Group, Thoracic Surgery Department, University Hospital Strasbourg, Strasbourg, France.
Pierre-Emmanuel
PE
Falcoz
Lung Transplantation Group, Thoracic Surgery Department, University Hospital Strasbourg, Strasbourg, France; EA 7293 "Stress Vasculaire et Tissulaire en Transplantation," Translational Medecine Federation Strasbourg, University of Strasbourg, Strasbourg, France.
Gilbert
G
Massard
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001982:Bronchial Diseases / Q000209:etiology / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006084:Graft Rejection / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016040:Lung Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055031:Primary Graft Dysfunction / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014181:Transplantation Immunology / Q000502:physiology; D016896:Treatment Outcome
D007166:Immunosuppressive Agents
anastomosis; bronchial healing; immunosuppressive regimen; lung graft infection; lung primary graft dysfunction; lung transplantation