Airway Complications after Lung Transplantation—A Contemporary Series of 400 Bronchial Anastomoses from a Single Center
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Lung Transplant Procedure and Perioperative Management
2.3. Endoscopic Management
2.4. Definitions
2.5. Data Collection, Statistical Analysis
3. Results
3.1. Bronchial Complications
3.2. Univariable Analysis of Risk Factors
3.3. Multivariable Analysis of Risk Factors
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Crespo, M.M.; McCarthy, D.P.; Hopkins, P.M.; Clark, S.C.; Budev, M.; Bermudez, C.A.; Benden, C.; Eghtesady, P.; Lease, E.D.; Leard, L.; et al. ISHLT Consensus Statement on adult and pediatric airway complications after lung transplantation: Definitions, grading system, and therapeutics. J. Heart Lung Transplant. 2018, 37, 548–563. [Google Scholar] [CrossRef]
- Dark, J.H. Pathophysiology and predictors of bronchial complications after lung transplantation. Thorac. Surg. Clin. 2018, 28, 357–363. [Google Scholar] [CrossRef]
- Yserbyt, J.; Dooms, C.; Vos, R.; Dupont, L.J.; Van Raemdonck, D.E.; Verleden, G.M. Anastomotic airway complications after lung transplantation: Risk factors, treatment modalities and outcome—A single-centre experience. Eur. J. Cardiothorac. Surg. 2016, 49, e1–e8. [Google Scholar] [CrossRef]
- Alvarez, A.; Algar, J.; Santos, F.; Lama, R.; Aranda, J.L.; Baamonde, C.; López-Pujol, J.; Salvatierra, A. Airway complications after lung transplantation: A review of 151 anastomoses. Eur. J. Cardiothorac. Surg. 2001, 19, 381–387. [Google Scholar] [CrossRef] [PubMed]
- Moreno, P.; Alvarez, A.; Algar, F.J.; Cano, J.R.; Espinosa, D.; Cerezo, F.; Baamonde, C.; Salvatierra, A. Incidence, management and clinical outcomes of patients with airway complications following lung transplantation. Eur. J. Cardiothorac. Surg. 2008, 34, 1198–1205. [Google Scholar] [CrossRef] [PubMed]
- Sundaresan, S.; Trachiotis, G.D.; Aoe, M.; Patterson, G.A.; Cooper, J.D. Donor lung procurement: Assessment and operative technique. Ann. Thorac. Surg. 1993, 56, 1409–1413. [Google Scholar] [CrossRef]
- Alvarez, A.; Salvatierra, A.; Lama, R.; Algar, J.; Cerezo, F.; Santos, F.; Robles, J.C.; Baamonde, C.; Pujol, J.L. Preservation with a retrograde second flushing of Eurocollins in clinical lung transplantation. Transplant. Proc. 1999, 31, 1088–1090. [Google Scholar] [CrossRef]
- Date, H.; Trulock, E.P.; Arcidi, J.M.; Sundaresan, S.; Cooper, J.D.; Patterson, G.A. Improved airway healing after lung transplantation. An analysis of 348 bronchial anastomoses. J. Thorac. Cardiovasc. Surg. 1995, 110, 1424–1433. [Google Scholar] [CrossRef] [PubMed]
- Lease, E.D.; Budev, M.M. Infectious complications in lung transplant recipients. Thorac. Surg. Clin. 2022, 32, 211–220. [Google Scholar] [CrossRef]
- Van De Wauwer, C.; Van Raemdonck, D.; Verleden, G.M.; Dupont, L.; De Leyn, P.; Coosemans, W.; Nafteux, P.; Lerut, T. Risk factors for airway complications within the first year after lung transplantation. Eur. J. Cardiothorac. Surg. 2007, 31, 703–710. [Google Scholar] [CrossRef] [PubMed]
- Schweiger, T.; Nenekidis, I.; Stadler, J.E.; Schwarz, S.; Benazzo, A.; Jaksch, P.; Hoetzenecker, K.; Klepetko, W.; Vienna Lung Transplant Program. Single running suture technique is associated with low rate of bronchial complications after lung transplantation. J. Thorac. Cardiovasc. Surg. 2020, 160, 1099–1108.e3. [Google Scholar] [CrossRef] [PubMed]
- Santacruz, J.F.; Mehta, A.C. Airway complications and management after lung transplantation: Ischemia, dehiscence, and stenosis. Proc. Am. Thorac. Soc. 2009, 6, 79–93. [Google Scholar] [CrossRef]
- Aigner, C.; Winkler, G.; Jaksch, P.; Seebacher, G.; Lang, G.; Taghavi, S.; Wisser, H.; Klepetko, W. Extended donor criteria for lung transplantation—A clinical reality. Eur. J. Cardiothorac. Surg. 2005, 27, 757–761. [Google Scholar] [CrossRef] [PubMed]
- Steen, S.; Sjöberg, T.; Massa, G.; Ericsson, L.; Lindberg, L. Safe pulmonary preservation for 12 hours with low-potassium-dextran solution. Ann. Thorac. Surg. 1993, 55, 434–440. [Google Scholar] [CrossRef] [PubMed]
- Novick, R.J.; Menkis, A.H.; McKenzie, F.N.; Reid, K.R.; Pflugfelder, P.W.; Kostuk, W.J.; Ahmad, D. The safety of low dose prednisone before and immediately after heart—Lung transplantation. Ann. Thorac. Surg. 1991, 51, 642–645. [Google Scholar] [CrossRef]
- Nunley, D.R.; Gal, A.A.; Vega, J.D.; Perlino, C.; Smith, P.; Lawrence, E.C. Saprophytic fungal infections and complications involving the bronchial anastomosis following human lung transplantation. Chest 2002, 122, 1185–1191. [Google Scholar] [CrossRef] [PubMed]
- Grimm, J.C.; Valero, V., 3rd; Kilic, A.; Magruder, J.T.; Merlo, C.A.; Shah, P.D.; Shah, A.S. Association between prolonged graft ischemia and primary graft failure or survival following lung transplantation. JAMA Surg. 2015, 150, 547–553. [Google Scholar] [CrossRef] [PubMed]
- Chhajed, P.N.; Tamm, M. Uncovered metallic stents for anastomotic dehiscence after lung transplantation. J. Heart Lung Transplant. 2005, 24, 1447–1448. [Google Scholar] [CrossRef]
- Maloney, J.D.; Weigel, T.L.; Love, R.B. Endoscopic repair of bronchial dehiscence after lung transplantation. Ann. Thorac. Surg. 2001, 72, 2109–2110. [Google Scholar] [CrossRef]
- Muñoz-Fos, A.; Cerezo Madueño, F.; Cosano, J.; Redel, J.; Gonzalez García, J.; Poveda, D.; Ruiz, E.; Moreno Casado, P.; Algar Algar, J.; Alvarez Kindelan, A.; et al. Early surgical management of bronchial dehiscence after single-lung transplantation: A case report. Transplant. Proc. 2020, 52, 596–598. [Google Scholar] [CrossRef]
- Saad, C.P.; Ghamande, S.A.; Minai, O.A.; Murthy, S.; Pettersson, G.; DeCamp, M.; Mehta, A.C. The role of self-expandable metallic stents for the treatment of airway complications after lung transplantation. Transplantation 2003, 75, 1532–1538. [Google Scholar] [CrossRef] [PubMed]
- Marulli, G.; Loy, M.; Rizzardi, G.; Calabrese, M.; Feltracco, P.; Sartori, F.; Rea, F. Surgical treatment of posttransplant bronchial stenoses: Case reports. Transplant. Proc. 2007, 39, 1973–1975. [Google Scholar] [CrossRef] [PubMed]
Total AC n = 50 (12.5%) | Intervention n = 32 (8%) | No Intervention n = 18 (4.5%) | Deaths n = 2 (0.5%) |
---|---|---|---|
Anastomotic stenosis | 14 (3.5%) | 6 (1.5%) | 0 |
Non-anastomotic stenosis | 11 (2.7%) | 5 (1.2%) | 0 |
Malacia | 3 (0.7%) | 4 (1%) | 0 |
Dehiscence | 4 (1%) | 2 (0.5%) | 2 (0.5%) |
OR (95% CI) | p | |
---|---|---|
Recipient-related independent variables | ||
Sex male | 2.30 (1.05–5.09) | 0.03 |
Age > 55 years | 1.15 (0.64–2.09) | 0.63 |
Cardiac comorbidities YES | 2.25 (1.15–4.37) | 0.01 |
Previous pulmonary hypertension YES | 1.39 (0.66–2.92) | 0.38 |
Perioperative steroid use YES Disease | 0.62 (0.20–1.32) | 0.21 |
● Emphysema | 0.96 (0.53–1.75) | 0.90 |
● Cystic fibrosis | 0.86 (0.43–1.72) | 0.67 |
● Pulmonary fibrosis | 0.79 (0.34–1.85) | 0.60 |
● Bronchiectasis | 0.62 (0.08–4.93) | 0.54 |
● Other | 1.96 (0.88–4.36) | 0.09 |
Donor-related independent variables | ||
Suboptimal donors | 1.64 (0.85–2.25) | 0.13 |
Intraoperative variables | ||
Type of Transplantation BLT | 0.79 (0.44–1.44) | 0.45 |
Anastomotic side right | 1.23 (0.66–2.28) | 0.51 |
Incision clamshell | 1.09 (0.58–2.04) | 0.78 |
CEC/ECMO YES | 1.82 (0.91–3.65) | 0.08 |
D/R bronchial size mismatch YES | 0.94 (0.47–1.88) | 0.87 |
Suture conventional | 3.04 (0.71–12.99) | 0.11 |
Postoperative variables | ||
Induction therapy No induction | 1.05 (0.54–2.03) | 0.88 |
PaO2/FiO2 < 300 YES | 2.71 (1.44–5.09) | 0.001 |
Primary Graft Dysfunction YES | 1.71 (0.91–3.19) | 0.09 |
Acute graft rejection YES | 1.08 (0.52–2.28) | 0.83 |
Mechanical ventilation > 72 h YES | 2.79 (1.48–5.20) | 0.001 |
Bronchial Infection YES | 3.25 (1.70–6.10) | <0.001 |
Bleeding YES | 1.84 (0.71–4.74) | 0.20 |
CLAD YES | 0.69 (0.28–1.70) | 0.41 |
Microbiome isolations after lung transplantation | ||
Candida spp. | 0.67 (0.23–1.90) | 0.45 |
Aspergillus spp. | 2.16 (1.03–4.56) | 0.03 |
Burkhodelia spp. | 1.01 (0.22–4.59) | 0.99 |
A. Xyloides | 0.32 (0.40–2.40) | 0.24 |
Escherichia spp. | 1.15 (0.25–5.32) | 1.15 |
Enterobacter spp. | 3.50 (0.63–19.90) | 0.12 |
Haemophilus spp. | 1.12 (0.37–3.36) | 0.84 |
Klebsiella spp. | 2.85 (0.54–15.10) | 0.20 |
Tuberculosis spp. | 1.59 (0.81–3.12) | 0.17 |
Pseudomona spp. | 1.60 (0.89–2.94) | 0.11 |
Staphilococus spp. | 1.07 (0.55–2.09) | 0.82 |
Serratia spp. | 0.99 (0.20–3.45) | 0.98 |
Streptomona spp. | 0.90 (0.20–4.15) | 0.92 |
Variables | OR | 95% CI | p Value |
---|---|---|---|
Gender male | 4.18 | 1.68–10.40 | 0.002 |
Cardiac comorbidities | 2.74 | 1.28–5.84 | 0.009 |
Mechanical Ventilation > 72 h postop. | 2.50 | 1.15–5.30 | 0.02 |
PaO2/FiO2 < 300 at 72 h postop. | 2.48 | 1.19–5.19 | 0.015 |
Primary Graft Dysfunction | 0.88 | 0.38–2.05 | 0.77 |
Acute cellular rejection | 0.84 | 0.35–1.96 | 0.68 |
Bronchial Infection | 2.16 | 1.0–4.70 | 0.05 |
Bleeding | 2.23 | 0.74–6.65 | 0.15 |
Aspergillus spp. bronchial isolation | 2.63 | 1.10–6.29 | 0.03 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Muñoz-Fos, A.; Moreno, P.; González, F.J.; Ruiz, E.; Vaquero, J.M.; Baamonde, C.; Cerezo, F.; Algar, J.; Ramos-Izquierdo, R.; Salvatierra, Á.; et al. Airway Complications after Lung Transplantation—A Contemporary Series of 400 Bronchial Anastomoses from a Single Center. J. Clin. Med. 2023, 12, 3061. https://doi.org/10.3390/jcm12093061
Muñoz-Fos A, Moreno P, González FJ, Ruiz E, Vaquero JM, Baamonde C, Cerezo F, Algar J, Ramos-Izquierdo R, Salvatierra Á, et al. Airway Complications after Lung Transplantation—A Contemporary Series of 400 Bronchial Anastomoses from a Single Center. Journal of Clinical Medicine. 2023; 12(9):3061. https://doi.org/10.3390/jcm12093061
Chicago/Turabian StyleMuñoz-Fos, Anna, Paula Moreno, Francisco Javier González, Eloisa Ruiz, Jose Manuel Vaquero, Carlos Baamonde, Francisco Cerezo, Javier Algar, Ricard Ramos-Izquierdo, Ángel Salvatierra, and et al. 2023. "Airway Complications after Lung Transplantation—A Contemporary Series of 400 Bronchial Anastomoses from a Single Center" Journal of Clinical Medicine 12, no. 9: 3061. https://doi.org/10.3390/jcm12093061
APA StyleMuñoz-Fos, A., Moreno, P., González, F. J., Ruiz, E., Vaquero, J. M., Baamonde, C., Cerezo, F., Algar, J., Ramos-Izquierdo, R., Salvatierra, Á., & Alvarez, A. (2023). Airway Complications after Lung Transplantation—A Contemporary Series of 400 Bronchial Anastomoses from a Single Center. Journal of Clinical Medicine, 12(9), 3061. https://doi.org/10.3390/jcm12093061