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

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 mates and 90 females; mean age: 48 years [range 15-66 years]). Indications for LTx were emphysema In = 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/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 (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 mate 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. (c) 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.