Risk Factors, Incidence, and Outcomes Associated With Clinically Significant Airway Ischemia

Authors

Gloria Li
Zejian Liu
Marcelo Salan-Gomez
Emma Keeney
Ethan D'Silva
Babith Mankidy
Andres Leon
Aladdein Mattar
Abdusallam Elsennousi
Jennalee Coster
Anupam Kumar
Bruno Rodrigues
Meng Li
Alexis Shafii
Puneet Garcha
Gabriel Loor

Publication Date

1-1-2024

Journal

Transplant International

DOI

10.3389/ti.2024.12751

PMID

38800671

PMCID

PMC11119282

PubMedCentral® Posted Date

5-10-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Male, Risk Factors, Middle Aged, Female, Retrospective Studies, Incidence, Lung Transplantation, Ischemia, Adult, Postoperative Complications, Aged, Lung, lung transplant, airway stenosis, airway ischemia, airway anastomosis, airway dehiscence

Abstract

Airway complications following lung transplantation remain an important cause of morbidity and mortality. We aimed to identify the incidence, risk factors and outcomes associated with clinically significant airway ischemia (CSAI) in our center. We reviewed 217 lung transplants (386 airway anastomoses) performed at our institution between February 2016 and December 2020. Airway images were graded using the 2018 ISHLT grading guidelines modified slightly for retrospective analysis. Airways were considered to have CSAI if they developed ischemia severity >B2, stenosis >50%, and/or any degree of dehiscence within 6-months of transplant. Regression analyses were used to evaluate outcomes and risk factors for CSAI. Eighty-two patients (37.8%) met criteria for CSAI. Of these, twenty-six (32%) developed stenosis and/or dehiscence, and 17 (21%) required interventions. Patients with CSAI had lower one-year (80.5% vs. 91.9%, p = 0.05) and three-year (67.1% vs. 77.8%, p = 0.08) survival than patients without CSAI. Factors associated with CSAI included younger recipient age, recipient diabetes, single running suture technique, performance of the left anastomosis first, lower venous oxygen saturation within 48-h, and takeback for major bleeding. Our single-center analysis suggests that airway ischemia remains a major obstacle in contemporary lung transplantation. Improving the local healing milieu of the airway anastomosis could potentially mitigate this risk.

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