Impact of Cold Ischemia Time on Frequency of Airway Complications Among Lung Transplant Recipients

Nęcki, Mirosław; Antończyk, Remigiusz; Pandel, Anastazja; Gawęda, Martyna; Latos, Magdalena; Urlik, Maciej; Stącel, Tomasz; Wajda-Pokrontka, Marta; Zawadzki, Fryderyk; Przybyłowski, Piotr; Zembala, Marian; Ochman, Marek

doi:10.1016/j.transproceed.2020.03.047

Cited by 11 publications

(5 citation statements)

References 19 publications

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“…Since the pathological basis of PGD is consistent with IRI [ 39 ], CIT is closely related to early allograft function [ 40 ]. Recently, CIT was also reported to have a significant correlation with postoperative complications of lung transplantation [ 41 ]. However, whether CIT could be used to predict PMV remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Establishment of a risk prediction model for prolonged mechanical ventilation after lung transplantation: a retrospective cohort study

Gao

et al. 2023

BMC Pulm Med

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Background Prolonged mechanical ventilation (PMV), mostly defined as mechanical ventilation > 72 h after lung transplantation with or without tracheostomy, is associated with increased mortality. Nevertheless, the predictive factors of PMV after lung transplant remain unclear. The present study aimed to develop a novel scoring system to identify PMV after lung transplantation. Methods A total of 141 patients who underwent lung transplantation were investigated in this study. The patients were divided into PMV and non-prolonged ventilation (NPMV) groups. Univariate and multivariate logistic regression analyses were performed to assess factors associated with PMV. A risk nomogram was then established based on the multivariate analysis, and model performance was further examined regarding its calibration, discrimination, and clinical usefulness. Results Eight factors were finally identified to be significantly associated with PMV by the multivariate analysis and therefore were included as risk factors in the nomogram as follows: the body mass index (BMI, P = 0.036); primary diagnosis as idiopathic pulmonary fibrosis (IPF, P = 0.038); pulmonary hypertension (PAH, P = 0.034); primary graft dysfunction grading (PGD, P = 0.011) at T0; cold ischemia time (CIT P = 0.012); and three ventilation parameters (peak inspiratory pressure [PIP, P < 0.001], dynamic compliance [Cdyn, P = 0.001], and P/F ratio [P = 0.015]) at T0. The nomogram exhibited superior discrimination ability with an area under the curve of 0.895. Furthermore, both calibration curve and decision-curve analysis indicated satisfactory performance. Conclusion A novel nomogram to predict individual risk of receiving PMV for patients after lung transplantation was established, which may guide preventative measures for tackling this adverse event. Graphic Abstract

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Section: Discussionmentioning

confidence: 99%

Establishment of a risk prediction model for prolonged mechanical ventilation after lung transplantation: a retrospective cohort study

Gao

et al. 2023

BMC Pulm Med

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“…Size matching was not associated with 10+ or 20+ year survival despite being a focus theme for the 2019 International Society for Heart and LTx report ( 3 ). Paradoxically, shorter cold ischemia time may appear to be a long-term risk factor; however ischemic time for double lungs reflects the mean value for both lungs, an important consideration for future UNOS studies ( 21 ). After propensity score matching for unilateral transplant alone, the association between longer ischemic time and survival disappeared entirely.…”

Section: Discussionmentioning

confidence: 99%

Twenty-year survival following lung transplantation

Miggins¹,

Reul²,

Barrett³

et al. 2023

J Thorac Dis

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Background Lung transplantation median survival has seen improvements due to recognition of short-term survival factors but continues to trail behind other solid organs due to limited understanding of long-term survivorship. Given the creation of the United Network for Organ Sharing (UNOS) database in 1986, it was difficult to accrue data on long-term survivors until recently. This study characterizes factors impacting lung transplant survival beyond 20 years, conditional to 1-year survival. Methods Lung transplant recipients listed in UNOS from 1987 to 2002 who survived to 1 post-transplant year were reviewed. Kaplan-Meier and adjusted Cox regression analyses were performed at 20 and 10 years to identify risk factors associated with long-term outcomes independent of their short-term effects. Results A total of 6,172 recipients were analyzed, including 472 (7.6%) recipients who lived 20+ years. Factors associated with increased likelihood of 20-year survival were female-to-female gender match, recipient age 25–44, waitlist time >1 year, human leukocyte antigen (HLA) mismatch level 3, and donor cause of death: head trauma. Factors associated with decreased 20-year survival included recipient age ≥55, chronic obstructive pulmonary disease/emphysema (COPD/E) diagnosis, donor smoking history >20 pack-years, unilateral transplant, blood groups O&AB, recipient glomerular filtration rate (GFR) <10 mL/min, and donor GFR 20–29 mL/min. Conclusions This is the first study identifying factors associated with multiple-decade survival following lung transplant in the United States. Despite its challenges, long-term survival is possible and more likely in younger females in good waitlist condition without COPD/E who receive a bilateral allograft from a non-smoking, gender-matched donor of minimal HLA mismatch. Further analysis of the molecular and immunologic implications of these conditions are warranted.

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“…We did not find a relation between ischemia time and development of AC in contrast to recent studies. However, these are studies with average longer ischemia time compared to our cohort, ranging from 354 min for single and 516 for double lung transplantation [ 26 , 27 ]. This study does not confirm previous reports that right sided anastomosis [ 9 ] is a risk factor for development of AC, previously attributed to bronchial artery anatomy.…”

Section: Discussionmentioning

confidence: 99%

Three Decades Single Center Experience of Airway Complications After Lung Transplantation

van Pel,

Gan,

van der Bij

et al. 2023

Transpl Int

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Post lung transplantation airway complications like necrosis, stenosis, malacia and dehiscence cause significant morbidity, and are most likely caused by post-operative hypo perfusion of the anastomosis. Treatment can be challenging, and airway stent placement can be necessary in severe cases. Risk factors for development of airway complications vary between studies. In this single center retrospective cohort study, all lung transplant recipients between November 1990 and September 2020 were analyzed and clinically relevant airway complications of the anastomosis or distal airways were identified and scored according to the ISHLT grading system. We studied potential risk factors for development of airway complications and evaluated the impact on survival. The treatment modalities were described. In 651 patients with 1,191 airway anastomoses, 63 patients developed 76 clinically relevant airway complications of the airway anastomoses or distal airways leading to an incidence of 6.4% of all anastomoses, mainly consisting of airway stenosis (67%). Development of airway complications significantly affects median survival in post lung transplant patients compared to patients without airway complication (101 months versus 136 months, p = 0.044). No significant risk factors for development of airway complication could be identified. Previously described risk factors could not be confirmed. Airway stents were required in 55% of the affected patients. Median survival is impaired by airway complications after lung transplantation. In our cohort, no significant risk factors for the development of airway complications could be identified.

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Impact of Cold Ischemia Time on Frequency of Airway Complications Among Lung Transplant Recipients

Cited by 11 publications

References 19 publications

Establishment of a risk prediction model for prolonged mechanical ventilation after lung transplantation: a retrospective cohort study

Establishment of a risk prediction model for prolonged mechanical ventilation after lung transplantation: a retrospective cohort study

Twenty-year survival following lung transplantation

Three Decades Single Center Experience of Airway Complications After Lung Transplantation

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