Eastern Cardiothoracic Surgical Society

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

Odds Ratio 95% Confidence Interval p-value
Recipient body mass index (BMI) > 30 1.407 1.043-1.898 0.815-2.149
Recipient transplanted from intensive care unit 1.321 0.766-2.278 0.317
Recipient non-hospitalized prior to transplant 0.949 0.623-1.445 0.806
Recipient supported with mechanical ventilation prior to transplant 1.323 0.815-2.149 0.257
Donor age > 40 years 0.701 0.518-0.948 0.021
Donor male gender 1.053 0.808-1.373 0.702
Donor mechanism of death, stroke 0.970 0.709-1.328 0.849
Donor mechanism of death, gunshot wound 1.405 1.038-1.900 0.028
Cold ischemia time 2-4 hours 0.801 0.577-1.113 0.186
Single left lung transplant 0.358 0.205-0.625 <0.001
Received bilateral lung transplant 1.002 0.708-1.419 0.990