Risk factors for airway complications within the first year after lung transplantation

Abstract

Objective: Lung transplantation (LTx) has enjoyed increasing success with better survival in recent years. Nevertheless, airway anastomotic complications (AC) are still a potential cause of early morbidity and mortality. In this retrospective cohort study we looked at possible predictors of AC within the first year after LTx. Methods: Between July 1991 and December 2004, 232 consecutive single (n = 102) and bilateral (n = 130) LTx were performed (142 males and 90 females; mean age: 48 years [range 15-66 years]). Indications for LTx were emphysema (n = 113), pulmonary fibrosis (n = 45), cystic fibrosis (n = 35), pulmonary hypertension (n = 10), sarcoidosis (n = 7) and miscellaneous (n = 22). Donor variables (age, gender, PaO 2 / FiO 2 , mechanical ventilation, ischemic time and preservation solution) and recipient variables (age, diagnosis, length, gender, pre-operative steroids, smoking, cytomegalovirus matching, LTx type, anastomotic type, wrapping and bypass) were evaluated in an univariate and multivariate model. Results: Fifty-seven complications occurred in 362 airway anastomoses (15.7%) of which 55 (15.2%) within the first year after transplantation. Six patients died as a result of AC (mortality 2.6%) during the first year after LTx. In a univariate analysis (321 airway anastomoses at risk), anastomotic type (

Therapeutic Bronchoscopy Improves Spirometry, Quality of Life, and Survival in Central Airway Obstruction

“…It has been associated with decreased lung function and worse survival [5,6,32]. It is also associated with prolonged mechanical ventilation, hospital and ICU length of stay, increased cost, and poor QOL [33,34]. …”

Bronchial healing after living-donor lobar lung transplantation

“…4 Previous studies have shown that infection with Aspergillus or Pseudomonas cepacia is a risk factor for AC. 3,10 In fact, in the present series the patients affected by stenosis were infected with Aspergillus terreus or MRSA.…”

“…1,2 According to recent reports, the incidence of ACs requiring intervention ranges from 7% to 15.7%, and 2.5%-4% of transplant patients die of ACs, which shows that further improvements are needed to promote bronchial healing. 3,4 Living-donor lobar lung transplantation (LDLLT) was developed at the University of Southern California, and has been established as a safe and reproducible procedure to deal with the shortage of cadaveric donors. 5,6 Considering the severity of the recipient's illness and the urgent nature of the transplantation, the recipient outcomes of LDLLT have been reported to be similar to or better than those of CLT.…”

Treatment of distal bronchial stenosis after bilateral lung transplantation

“…Wauwer и соавт. показали, что факто-рами риска развития бронхиальных осложнений в первый год после трансплантации легких являются применение техники телескопического анастомоза, а также рост реципиента и время искусственной вентиляции легких у донора [10]. Также многие ав-торы придают важную роль в формировании стено-зов инфекционным и воспалительным процессам в трахеобронхиальном дереве донорских легких как на стадии кондиционирования, так и после выпол-нения трансплантации [2,11].…”