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. 2016 Oct;35(10):1206-1211.
doi: 10.1016/j.healun.2016.04.019. Epub 2016 May 6.

Airway complications after lung transplantation: Contemporary survival and outcomes

J W Awori Hayanga  1 , Jonathan K Aboagye  2 , Norihisa Shigemura  3 , Heather K Hayanga  3 , Edward Murphy  4 , Asghar Khaghani  4 , Jonathan D'Cunha  3
Affiliations

Airway complications after lung transplantation: Contemporary survival and outcomes

J W Awori Hayanga et al. J Heart Lung Transplant. 2016 Oct.

Abstract

Background: Airway complications are rare and cause increased morbidity and mortality after 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), 1-year (54.6% vs 84.4%, p < 0.001), 3-year (38.7% vs 67.4%, p < 0.001) and 5-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 1-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 to 90 ml/min/1.73 m2 (HR 1.61, p < 0.001), GFR <60 ml/min/1.73 m2 (HR 1.13, p = 0.01), non-ICU hospitalization (HR 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. Chronic obstructive pulmonary disease/emphysema was protective compared with idiopathic pulmonary fibrosis (HR 0.85, p = 0.008).

Conclusion: Airway complications are associated with a significant mortality burden.

Keywords: airway complications; contemporary; lung allocation score; lung transplantation; outcomes; predictors; survival.

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