Abstract
Background. Anastomotic airway complications (AC) give rise to morbidity and mortality after lung transplantation. A more profound knowledge about the prevalence of AC and the predisposing factors and evolving therapeutic strategies for AC is needed.
Methods. We conducted a retrospective analysis of 808 consecutive bronchial anastomoses. A patient-dependent score (PDS) and Shennib and Massard anastomosis classification was allocated to each AC. We aimed to define risk factors associated with AC and to develop a model that might predict the most appropriate treatment strategy for AC.
Results. The overall prevalence of AC was 10%. After multivariate analysis, significant risk factors for AC were receptor age (OR (95%CI) 3.69 (1.37-9.93)), pre-operative TLC (OR 2.06 (1.01-4.22)), microbiological colonization (OR 2.34 (1.30-4.23)), right-sided anastomosis (OR 2.07 (1.16-3.70)) and Pa02/FiO2 <300 (OR 2.19 (1.17-4.10)). No specific treatment was initiated in 59 AC and a spontaneous resolution was obtained in 48. A logistic regression model including the case-specific Shennib and Massard classification along with a PDS correctly predicted spontaneous resolution in 91% and necessity for extended treatment of AC in 87%.
Conclusion. Anastomotic airway complications are not infrequent after lung transplantation, but the identified risk factors are not easily controllable. The indication for either a conservative strategy or invasive intervention should be carefully considered, since most cases resolve or stabilize with time.
- © 2014 ERS