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Eur J Cardiothorac Surg 2007;31:703-710. doi:10.1016/j.ejcts.2007.01.025
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

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

^a Department of Thoracic Surgery, UZ Leuven, Belgium
^b Department of Pneumology, UZ Leuven, Belgium

Received 1 September 2006; received in revised form 29 December 2006; accepted 15 January 2007.

^_* Corresponding author. Address: Department of Thoracic Surgery, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. Tel.: +32 16 34 68 23; fax: +32 16 34 68 24. (Email: dirk.vanraemdonck{at}uzleuven.be).

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, PaO₂/FiO₂, 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 (7/17 [Telescoping] vs 48/304 [End-to-end]; p = 0.011), recipient length (p = 0.0012), donor ventilation (>50–70 h<; p = 0.0015) and recipient male gender (43/191 [M] vs 12/130 [F]; p = 0.0092) were significant predictors of AC. Three factors remained significant predictors in the multivariate analysis: telescoping technique (p = 0.0495), recipient length (p = 0.0029) and donor ventilation (p = 0.003). Conclusions: Tall recipients and those receiving lungs from donors with prolonged ventilation have an increased risk to develop bronchial anastomotic problems. An end-to-end anastomosis should be preferred. Airway complications remain a matter of concern after lung transplantation.

Key Words: Lung transplantation • Airway complication • Bronchus

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