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|