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

Eur J Cardiothorac Surg. 2007 Apr;31(4):703-10. doi: 10.1016/j.ejcts.2007.01.025. Epub 2007 Feb 15.


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, PaO(2)/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 (>50-70h<; 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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anastomosis, Surgical / adverse effects
  • Anastomosis, Surgical / methods
  • Bronchi / blood supply
  • Bronchi / physiopathology
  • Bronchial Diseases / etiology*
  • Bronchial Diseases / mortality
  • Bronchial Diseases / physiopathology
  • Female
  • Humans
  • Lung / blood supply
  • Lung / surgery
  • Lung Transplantation* / mortality
  • Male
  • Middle Aged
  • Postoperative Complications / etiology*
  • Postoperative Complications / mortality
  • Postoperative Complications / physiopathology
  • Reoperation
  • Respiration, Artificial
  • Retrospective Studies
  • Risk Factors
  • Sex Factors
  • Time Factors
  • Wound Healing / physiology