Airway Complications after Lung Transplantation: Contemporary Survival and Outcomes

• Published in: The Journal of heart and lung transplantation Vol. 35; no. 10; pp. 1206 - 1211
• Main Authors: Hayanga, J.W. Awori, Aboagye, Jonathan K, Shigemura, Norihisa, Hayanga, Heather K, Murphy, Edward, Khaghani, Asghar, D’Cunha, Jonathan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2016
• Subjects: airway complications; contemporary; Humans; Idiopathic Pulmonary Fibrosis; lung allocation score; Lung Transplantation; Male; outcomes; predictors; Pulmonary Emphysema; Retrospective Studies; Surgery; survival; Survival Rate; Tissue Donors; predictors; contemporary; outcomes; survival; lung transplantation; lung allocation score; airway complications
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2016.04.019

Introduction Airway complications are rare and cause increased morbidity and mortality post-lung transplantation (LT). We sought to examine risk factors associated with this complication and its impact on survival. Methods We retrospectively evaluated United Network for Organ Sharing data from 2000 to 2012. A backward stepwise logistic regression was performed on recipient-, donor-, and transplant-related variables to select independent risk factors associated with airway complications and mortality. Survival was evaluated using the Kaplan-Meier method. Results We evaluated 16,156 consecutive adult LT recipients, among whom 233 (1.4%) developed airway complications. Predictors of increased risk of airway complications included male gender (odds ratio [OR] 1.61, p=0.001), advancing recipient age (OR 1.02, p<0.001), and pre-transplantation admission to the intensive care unit (ICU) (OR 2.13, p< 0.001). The 30-day (89.6% vs. 96.2%, p-0.001), 90-day (69.9% vs. 93.1% p <0.001), one-year (54.6% vs. 84.4%, p<0.001), three-year (38.7% vs. 67.4%, p<0.001), and five-year (33.2% vs. 54.2%, p<0.001) survival rates were each significantly reduced in recipients with airway complications. Factors associated with an increased risk of one-year mortality included recipient age (hazard ratio [HR] 1.01, p<0.001), use of extracorporeal mechanical support (HR 1.5, p=0.01), diagnosis of cystic fibrosis (HR 1.22, p=0.01), glomerular filtration rate (GFR) 60-90 (HR 1.61, p<0.001), GFR <60 (HR 1.13, p=0.01), non ICU hospitalization (1.32, p<0.001), pre-transplantation ICU hospitalization (HR 2.54, p<0.001), donor with positive serology for cytomegalovirus (HR 1.16, p<0.001), and donor with a smoking history (HR 1.19, p<0.001). Double LT (HR 0.83, p<0.001) was associated with a decreased risk of death. COPD/emphysema was protective compared to idiopathic pulmonary fibrosis (HR 0.85, p=0.008). Conclusion Airway complications are associated with a significant mortality burden.