Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan-Dec:16:17534666221110354.
doi: 10.1177/17534666221110354.

Incidence and risk factors of anastomotic complications after lung transplantation

Agathe Delbove  1   2 , Thomas Senage  3   4 , Pierre Gazengel  5   6 , Adrien Tissot  5 , Philippe Lacoste  3 , Laurent Cellerin  5 , Christian Perigaud  3 , Isabelle Danner-Boucher  5 , Arnaud Cavailles  5 , Thierry Lepoivre  4 , Antoine Mugniot  3 , Johanna Nicolet  7 , Delphine Horeau-Langlard  5 , Nicolas Groleau  7 , Yannick Fedun  8 , Bertrand Rozec  7 , Antoine Magnan  5   9 , Jean-Christian Roussel  3 , François-Xavier Blanc  5
Affiliations

Incidence and risk factors of anastomotic complications after lung transplantation

Agathe Delbove et al. Ther Adv Respir Dis. 2022 Jan-Dec.

Abstract

Background: Anastomotic complications are common after lung transplantation (1.4-33% of cases) and still associated with a high morbi-mortality.

Methods: The current study is a monocenter retrospective analysis of symptomatic anastomotic complications (SAC) occurring after lung transplantation between 2010 and 2016, using the macroscopic, diameter, and suture (M-D-S) classification from consensus of French experts in bronchoscopy. The objectives were to determine incidence from surgery, risk factors, and impact of survival of SAC. We defined SAC as M-D-S abnormalities (stenosis ⩾ 50% or dehiscence) requiring bronchoscopic or surgical interventions.

Results: A total of 121 patients were included. SAC occurred in 26.5% of patients (n = 32), divided in symptomatic stenosis for 23.7% (n = 29), and symptomatic dehiscence in 2.5% (n = 3). In multivariate analysis, donor bacterial lung infection [HR 2.08 (1.04-4.17), p = 0.04] and age above 50 years [HR 3.26 (1.04-10.26), p = 0.04] were associated with SAC occurrence. Cystic fibrosis etiology was associated with better survival on Kaplan-Meier curve (p < 0.001). SAC [HR 2.15 (1.07-4.32), p = 0.03] was independently associated with worst survival. The 29 symptomatic patients because of stenosis required endoscopic procedure, of whom 16 patients needed bronchial stent placement. Four patients underwent surgery: three patients because of dehiscence and one because of severe bilateral stenosis (re-transplantation).

Discussion: SAC occurred in 26.5% of patients. Donor lung infection was the only alterable identified factors. The increase rate of SAC in older patients above 50 years of age encourages in regular endoscopic monitoring.

Keywords: airway complications; lung transplantation; risk factors; symptomatic anastomotic complications.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: B.R. reports grants and personal fees outside the submitted work. Other authors: none.

Figures

Figure 1.
Figure 1.
Flowchart of patients screened during the study period, excluded and finally included, with the repartition of patients with and without SAC.
Figure 2.
Figure 2.
Survival without SAC depending on (a) graft etiology and (b) recipient age.
See this image and copyright information in PMC

References

    1. Crespo MM, McCarthy DP, Hopkins PM, et al.. ISHLT consensus statement on adult and pediatric airway complications after lung transplantation: definitions, grading system, and therapeutics. J Heart Lung Transplant 2018; 37: 548–563. - PubMed
    1. Pettersson GB, Karam K, Thuita L, et al.. Comparative study of bronchial artery revascularization in lung transplantation. J Thorac Cardiovasc Surg 2013; 146: 894–900. - PubMed
    1. Dutau H, Vandemoortele T, Laroumagne S, et al.. A new endoscopic standardized grading system for macroscopic central airway complications following lung transplantation: the MDS classification. Eur J Cardiothorac Surg 2014; 45: e33–e38. - PubMed
    1. Awori Hayanga JW, Aboagye JK, Shigemura N, et al.. Airway complications after lung transplantation: contemporary survival and outcomes. J Heart Lung Transplant 2016; 35: 1206–1211. - PubMed
    1. Cho EN, Haam SJ, Kim SY, et al.. Anastomotic airway complications after lung transplantation. Yonsei Med J 2015; 56: 1372–1378. - PMC - PubMed