Airway complications after lung transplantation: risk factors and survival

Abstract

Introduction: Airway complications (AC) are a source of morbidity and mortality after lung transplantation (LT). AC can be classified as necrosis, dehiscence, fistulae, infections, stenosis, granulomas or malacia.

Aim: The purposes of this retrospective study were to determine the rate of AC in our LT population, identify associated risk factors and define whether AC affect patient’s survival.

Methods: Between November 2002 and July 2019, 150 patients underwent LT (single n=36, double n=114; 89 males; mean age 43 years±18). Indications were ILD (n=56), emphysema (n=13), cystic fibrosis (n=66), pulmonary hypertension (n=7) and miscellaneous (n=8). Donor variables (height, gender, smoking history, PaO2/FiO2, ICU stay, amine administration, cause of death, ex vivo lung perfusion, EVLP) and recipient variables (age, gender, diagnosis, length donor/recipient ratio, LT type and side, ischemic time (IT), use of ECMO, ICU stay time, need of tracheostomy, pre-post intervention complications, early and chronic rejection) were evaluated. 45 patients (30%) developed at least one AC.

Results: Of the 45 AC, 29 were bronchial stenosis, 13 dehiscence, 1 bronchomalacia, 1 granuloma and 1 fistula. A correlation was found between AC and both ICU stay and need of tracheostomy (p=0.005) while IT, side of transplant, ECMO, EVLP and recipient diagnosis did not show any correlation with AC. No patient died as a result of AC. Overall survival was similar for patients with or without AC.

Conclusions: The rate of AC in our LT population was comparable with other reports. Longer ICU stay and need of tracheostomy lead to prolonged mechanical ventilation possibly facilitating AC, which do not seem to affect patients’survival.