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Comparative Study
. 2013 Sep;96(3):1008-17; discussion 1017-8.
doi: 10.1016/j.athoracsur.2013.01.104. Epub 2013 Jul 18.

A comparative analysis of bronchial stricture after lung transplantation in recipients with and without early acute rejection

Anthony W Castleberry  1 , Mathias Worni, Maragatha Kuchibhatla, Shu S Lin, Laurie D Snyder, Scott L Shofer, Scott M Palmer, Ricardo Pietrobon, R Duane Davis, Matthew G Hartwig
Affiliations
Comparative Study

A comparative analysis of bronchial stricture after lung transplantation in recipients with and without early acute rejection

Anthony W Castleberry et al. Ann Thorac Surg. 2013 Sep.

Abstract

Background: Risk factors and outcomes of bronchial stricture after lung transplantation are not well defined. An association between acute rejection and development of stricture has been suggested in small case series. We evaluated this relationship using a large national registry.

Methods: All lung transplantations between April 1994 and December 2008 per the United Network for Organ Sharing (UNOS) database were analyzed. Generalized linear models were used to determine the association between early rejection and development of stricture after adjusting for potential confounders. The association of stricture with postoperative lung function and overall survival was also evaluated.

Results: Nine thousand three hundred thirty-five patients were included for analysis. The incidence of stricture was 11.5% (1,077/9,335), with no significant change in incidence during the study period (P=0.13). Early rejection was associated with a significantly greater incidence of stricture (adjusted odds ratio [AOR], 1.40; 95% confidence interval [CI], 1.22-1.61; p<0.0001). Male sex, restrictive lung disease, and pretransplantation requirement for hospitalization were also associated with stricture. Those who experienced stricture had a lower postoperative peak percent predicted forced expiratory volume at 1 second (FEV1) (median 74% versus 86% for bilateral transplants only; p<0.0001), shorter unadjusted survival (median 6.09 versus 6.82 years; p<0.001) and increased risk of death after adjusting for potential confounders (adjusted hazard ratio 1.13; 95% CI, 1.03-1.23; p=0.007).

Conclusions: Early rejection is associated with an increased incidence of stricture. Recipients with stricture demonstrate worse postoperative lung function and survival. Prospective studies may be warranted to further assess causality and the potential for coordinated rejection and stricture surveillance strategies to improve postoperative outcomes.

Keywords: 12; 95% CI; 95% confidence interval; AOR; BMI; FEV(1); IQR; OPTN; Organ Procurement and Transplantation Network; Po(2); UNOS; United Network for Organ Sharing; adjusted odds ratio; arterial partial pressure of oxygen; body mass index; forced expiratory volume at 1 second (as a percent of the patient's predicted value); interquartile range.

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Figures

Figure 1
Figure 1. Study inclusion algorithm
Figure 2
Figure 2. Trends in bronchial stricture incidence and endobronchial therapy by year of transplant
Figure 3
Figure 3. Unadjusted Kaplan-Meier survival curves for patients with and without bronchial stricture (combined heart/lung excluded)
Figure 4
Figure 4. Unadjusted Kaplan-Meier survival curves for patients with bronchial stricture receiving stent vs. no stent. †
See this image and copyright information in PMC

References

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