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Meta-Analysis
. 2021 Apr 1;105(4):711-722.
doi: 10.1097/TP.0000000000003407.

Evaluating the Impact of Pulmonary Artery Obstruction After Lung Transplant Surgery: A Systematic Review and Meta-analysis

Nicolas Kumar  1 , Nasir Hussain  1 , Julia Kumar  1 , Michael K Essandoh  1 , Amar M Bhatt  1 , Hamdy Awad  1 , William J Perez  1 , Bryan A Whitson  2 , Asvin M Ganapathi  2 , Nahush A Mokadam  2 , Leonid Gorelik  1 , Katja Turner  1 , Manoj H Iyer  1
Affiliations
Meta-Analysis

Evaluating the Impact of Pulmonary Artery Obstruction After Lung Transplant Surgery: A Systematic Review and Meta-analysis

Nicolas Kumar et al. Transplantation. .

Abstract

Background: Pulmonary artery obstruction is an uncommon but significant complication after lung transplantation. Although numerous reports have documented its occurrence, the hemodynamic parameters associated with its presentation and diagnostic considerations remain ill-defined. This systematic review summarizes evidence in the literature surrounding pulmonary artery obstruction after lung transplantation surgery.

Methods: Databases were searched for all articles and abstracts reporting on pulmonary artery obstruction. Data collected included the number of patients studied, patient characteristics, incidences of pulmonary artery obstruction, and timing and imaging modality used for diagnosis.

Results: Thirty-four full-text citations were included in this review. The point prevalence of pulmonary artery obstruction was 3.66%. The peak pulmonary artery velocity associated with obstruction was found to be 2.60 ± 0.58 m/s. The diameter of the obstructed pulmonary artery predictive of poor outcomes was noted to be 0.78 ± 0.40 cm. The majority of diagnoses were made in the late postoperative period using pulmonary angiogram and transesophageal echocardiography. Overall, 76% of patients (47 of 62) required emergent procedural reintervention, and 23% of patients (14 of 62) diagnosed with pulmonary artery obstruction died during their hospital stay.

Conclusions: This systematic review underscores the importance of identifying pulmonary artery obstruction immediately after lung transplant surgery. The clinical implications of these results warrant the development of identification and management strategies for early detection of irregularities in pulmonary artery anastomosis in lung transplant patients.

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Conflict of interest statement

M.K.E. is a consultant for Boston Scientific and S4 Medical. N.A.M. is a consultant for Abbott, Medtronic, SynCardia, and Carmat. The other authors declare no conflicts of interest.

References

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    1. Kumar N, Essandoh M, Bhatt A, et al. Pulmonary cuff dysfunction after lung transplant surgery: a systematic review of the evidence and analysis of its clinical implications. J Heart Lung Transplant. 2019; 38:530–544
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    1. González-Fernández C, González-Castro A, Rodríguez-Borregán JC, et al. Pulmonary venous obstruction after lung transplantation. Diagnostic advantages of transesophageal echocardiography. Clin Transplant. 2009; 23:975–980

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