Novel Association Between AMR and Airway Complications Among Lung Transplant Recipients

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-07-01 DOI:10.1016/j.transproceed.2025.06.006

Zehra Dhanani , Alonso Marquez , Omar Al Omari , Fatima Anjum

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引用次数: 0

Abstract

Introduction

Airway complications (AC) such as stenosis and dehiscence are major challenges following lung transplantation, occurring in 1.4% to 44% of recipients and often linked to donor bronchial ischemia. Despite advances in surgical and bronchoscopic techniques, predictors for AC still remain unclear. This study aimed to evaluate the prevalence of AC and identify potential risk factors in a contemporary cohort.

Methods

We retrospectively analyzed 220 lung transplant recipients (2020–2023) at a high-volume center. Airway complications were categorized (stenosis, dehiscence, ischemia/necrosis, malacia) per ISHLT guidelines. Baseline characteristics and outcomes were compared between patients with and without AC using chi-squared and Wilcoxon rank-sum tests. Multivariate logistic regression evaluated associations with factors such as antibody-mediated rejection (AMR), microbial colonization, surgical techniques, and clinical outcomes.

Results

Airway complications were observed in 17.2% of patients, with stenosis (12.7%) being the most common. Among those with stenosis, 18 patients (8.2% of the total cohort) had preceding ischemia/necrosis noted on earlier surveillance bronchoscopy. Malacia occurred in 3.1% of the patients. A combination of 2 or more complications was identified in 1.3% of patients. Multivariate analysis revealed that AMR significantly increased the risk of AC (adjusted odds ratio [aOR] 5.554, P = .013). Additional risk factors included Pseudomonas colonization (aOR 2.728, P = .014), Aspergillus colonization (aOR 3.623, P = .026), and the telescoping surgical technique (P = .038) in the comparative analysis.

Conclusion

Airway complications remain prevalent despite advancements in lung transplantation. AMR, microbial colonization, and the telescoping technique are significant contributors to AC. These findings underscore the need for early intervention and further research into immunological mechanisms to improve patient outcomes.

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肺移植受者AMR与气道并发症之间的新关联。

气道并发症（AC）如狭窄和裂开是肺移植后的主要挑战，发生在1.4%至44%的受体中，通常与供体支气管缺血有关。尽管外科手术和支气管镜检查技术有所进步，但AC的预测因素仍不清楚。本研究旨在评估当代队列中AC的患病率并确定潜在的危险因素。方法：我们回顾性分析了一个大容量中心的220例肺移植受者（2020-2023）。根据ISHLT指南对气道并发症进行分类（狭窄、开裂、缺血/坏死、软化）。使用卡方检验和Wilcoxon秩和检验比较有无AC患者的基线特征和结果。多变量logistic回归评估了与抗体介导的排斥反应（AMR）、微生物定植、手术技术和临床结果等因素的相关性。结果：17.2%的患者出现气道并发症，其中以狭窄（12.7%）最为常见。在狭窄的患者中，18例患者（占总队列的8.2%）在早期支气管镜检查中发现有缺血/坏死。3.1%的患者出现了马拉西亚。1.3%的患者合并2种或2种以上的并发症。多因素分析显示，AMR显著增加AC的风险（校正优势比[aOR] 5.554, P = 0.013）。其他危险因素包括假单胞菌定殖（aOR为2.728,P = 0.014）、曲霉菌定殖（aOR为3.623,P = 0.026）和伸缩式手术技术（P = 0.038）。结论：尽管肺移植技术取得了进步，但气道并发症仍然普遍存在。AMR、微生物定植和伸缩技术是AC的重要因素。这些发现强调了早期干预和进一步研究免疫机制以改善患者预后的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.