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. 2022 Sep;14(9):3285-3294.
doi: 10.21037/jtd-22-213.

Bronchial artery revascularization in lung transplantation: a systematic review and meta-analysis

Danial Ahmad  1 , Thomas J O'Malley  1 , Andrew M Jordan  1 , Elizabeth J Maynes  1 , Abhiraj Saxena  1 , Kyle W Prochno  1 , Taufiek K Rajab  2 , Howard T Massey  1 , Richard C Daly  3 , Vakhtang Tchantchaleishvili  1
Affiliations

Bronchial artery revascularization in lung transplantation: a systematic review and meta-analysis

Danial Ahmad et al. J Thorac Dis. 2022 Sep.

Abstract

Background: Bronchial artery revascularization (BAR) during lung transplantation has been hypothesized to improve early tracheal healing and delay the onset of bronchiolitis obliterans syndrome (BOS). We aimed to assess the outcomes of BAR after lung transplantation.

Methods: Electronic search in Ovid Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, and Cochrane Controlled Trials Register (CCTR) databases was performed to identify all relevant studies published about lung transplantation with BAR. Studies discussing lung transplantation utilizing BAR were included while those without outcome data such as BOS and survival were excluded. Cohort-level data were extracted and pooled for analysis. A binary outcome meta-analysis of proportions with logit transformation was conducted. Newcastle-Ottawa scale was used for risk of bias assessment.

Results: Seven studies were selected for the analysis comprising 143 patients. Mean patient age was 47 (95% CI: 40-55) years. Sixty-one percent (48-72%) were male. Seventy-three percent (65-79%) of patients underwent double lung transplant while 27% (21-25%) underwent single lung transplant. In patients with postoperative angiography, successful BAR was demonstrated in 93% (82-97%) of all assessed conduits. The 30-day/in-hospital mortality was 6% (3-11%). Seventy-nine percent (63-89%) of patients were free from rejection at three months. Eighty-three percent (29-98%) of patients were free from signs of airway ischemia at three and six months. Pooled survival at one year and five years was 87% (78-92%) and 71% (46-87%), respectively, with a mean follow-up time of 21 (3-38) months. Pooled freedom from bronchiolitis obliterans was 86% (77-91%) at two years.

Conclusions: While this systematic review and meta-analysis is limited by the available surgeons, institutions, and papers discussing a highly specialized technique, it does show that BAR is a viable technique to minimize BOS and early anastomotic intervention following lung transplantation.

Keywords: Lung transplant; bronchial artery revascularization (BAR); bronchiolitis obliterans syndrome (BOS).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-213/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
PRISMA flow diagram illustrating the search strategy. CCTR, Cochrane Controlled Trials Register; CINAHL, Cumulative Index of Nursing and Allied Health Literature.
Figure 2
Figure 2
Pooled survival of patients undergoing lung transplant with bronchial artery revascularization. BOS, bronchiolitis obliterans syndrome.
Figure 3
Figure 3
Demonstration of freedom from bronchiolitis obliterans following bronchial artery revascularization.
Figure 4
Figure 4
Meta-regression analysis between Log 30-day/in-hospital mortality and time (publication year).
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