Risk Factors and Outcomes Associated with Early Airway Dehiscence Following Lung Transplantation
Neel Ranganath¹, Jad Malas¹, Katherine G. Phillips¹, Gregory J. Bittle², Melissa B. Lesko¹, Luis F. Angel¹, Bonnie E. Lonze¹, Zachary N. Kon¹, ¹New York University Langone Health, New York NY, USA, ²University of Maryland School of Medicine, Baltimore, MD, USA

OBJECTIVE: Anastomotic complications occur in 7-18% of lung transplants, but no large multi-institutional analyses to determine risk factors for airway dehiscence(AD) exist. Using national registry data, we compared pre-operative recipient/donor risk factors and post-operative outcomes in patients with and without AD.

METHODS: Data on adult lung transplants between 2007-2017 were provided by the Scientific Registry of Transplant Recipients. Recipient/donor demographics were compared with regards to AD, and multivariable logistic regression identified independent risk factors for AD. Kaplan-Meier curves and log-rank tests described mortality and graft survival.

RESULTS: 275/18122 recipients (1.5%) experienced AD. These recipients were more often male (71.6% vs 59.6%, p<0.001), obese (20.1% vs 15.6%, p=0.041), transplanted from ICU (17.5% vs 11.0%, p=0.001), and mechanically ventilated (11.6% vs 6.9%, p=0.002). AD was not associated with recipient steroid use (51.9% vs 47.7%, p=0.194) or lung disease diagnosis group. Donor diabetes (8.0% vs 7.0%, p=0.482) and donor smoking (7.4% vs 9.0%, p=0.449) were also not associated with AD. Patients with AD were more likely to have received bilateral lungs (78.5% vsb68.3%, p<0.001) and less likely to have received a single left lung (6.5% vs 17.3%, p<0.001). Cold ischemia time between 2-4 hours was less common in the AD group (17.2% vs 23.7%, p=0.013). Multivariable analysis revealed recipient obesity and donor gunshot death as independent predictive factors for AD, while donor age>40 and single left lung transplant were negative predictive factors (Table 1). Mortality and graft failure were both significantly higher in the AD group (Figure 1).

CONCLUSIONS: We identified independent risk factors for AD and confirmed poor post-operative outcomes. However, many known impediments to wound healing such as chronic steroid use, diabetes, and smoking did not appear to be associated with AD.

Table 1 – Independent Predictors of Airway Dehiscence by Multivariable Regression