Siddhartha G. Kapnadak MD , Kathleen J. Ramos MD, MS , Rachel Flodin MS , Sanaa Mansoor MD , Kyle Bilodeau MD , Peter Beidler BS , Erika D. Lease MD , Ryan Thomas BS , Richard Dubois MD , Jay Pal MD, PhD , Michael S. Mulligan MD
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Our objectives were to (1) assess the impact of pretransplant disease–modifying medications and post-transplant hypotension, hypovolemia, and mechanical ventilation on the risk of airway complications; (2) evaluate the association of airway complications with post-transplant lung function and survival.</div></div><div><h3>Methods</h3><div>One hundred and forty-five bilateral lung transplant recipients at our center were included. Demographics, pretransplant medications, post-transplant intensive care unit variables, and lung function were compared between recipients who did vs did not develop airway complications. Post-transplant survival was estimated using Kaplan-Meier analysis.</div></div><div><h3>Results</h3><div>Forty-eight (33.1%) recipients (75% male) developed airway complications. There were no significant associations in pretransplant exposure to prednisone (including by dose), other immunosuppressants, or antifibrotics, alone or in any combination, with the development of airway complications. There were no differences in ventilation pressures, but recipients with airway complications had higher peak vasopressor-inotropic scores (18.0 vs 13.0, <em>p</em> = 0.021), lactate levels (9.1 vs 6.8, <em>p</em> = 0.017), need for hemodialysis (22.9% vs 10.3%, <em>p</em> = 0.042), and net fluid balance at 48 hours (10.6 vs 8.9 liters, <em>p</em> = 0.028), respectively, compared to those without. Airway complications were associated with significantly worse survival (HR 2.74 [95% CI 1.35, 5.55], <em>p</em> = 0.004) and lung function (peak forced expiratory value in 1 second 74.8% vs 86.3% predicted, respectively, <em>p</em> = 0.013).</div></div><div><h3>Conclusions</h3><div>Postoperative hypotension and hypoperfusion are associated with increased risk for airway complications after lung transplantation. Airway complications are associated with poor outcomes, and further studies are needed to delineate risk-mitigation strategies.</div></div>","PeriodicalId":100741,"journal":{"name":"JHLT Open","volume":"9 ","pages":"Article 100315"},"PeriodicalIF":0.0000,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Airway complications after lung transplantation: Perioperative risk factors and clinical outcomes\",\"authors\":\"Siddhartha G. Kapnadak MD , Kathleen J. 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Demographics, pretransplant medications, post-transplant intensive care unit variables, and lung function were compared between recipients who did vs did not develop airway complications. Post-transplant survival was estimated using Kaplan-Meier analysis.</div></div><div><h3>Results</h3><div>Forty-eight (33.1%) recipients (75% male) developed airway complications. There were no significant associations in pretransplant exposure to prednisone (including by dose), other immunosuppressants, or antifibrotics, alone or in any combination, with the development of airway complications. There were no differences in ventilation pressures, but recipients with airway complications had higher peak vasopressor-inotropic scores (18.0 vs 13.0, <em>p</em> = 0.021), lactate levels (9.1 vs 6.8, <em>p</em> = 0.017), need for hemodialysis (22.9% vs 10.3%, <em>p</em> = 0.042), and net fluid balance at 48 hours (10.6 vs 8.9 liters, <em>p</em> = 0.028), respectively, compared to those without. 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引用次数: 0
摘要
背景：肺移植术后气道并发症是常见的，并导致较差的预后。可以减轻围手术期危险因素以降低风险的资料有限。我们的目标是(1)评估移植前疾病改善药物和移植后低血压、低血容量和机械通气对气道并发症风险的影响；(2)评估气道并发症与移植后肺功能和生存率的关系。方法选取我院145例双侧肺移植受者。统计数据、移植前用药、移植后重症监护病房变量和肺功能在有和没有发生气道并发症的受者之间进行了比较。移植后生存率采用Kaplan-Meier分析。结果48例（33.1%）患者出现气道并发症，其中男性占75%。移植前单独或联合使用强的松（包括剂量）、其他免疫抑制剂或抗纤维化药物与气道并发症的发生无显著相关性。通气压力没有差异，但与没有通气压力的患者相比，有气道并发症的患者有更高的血管加压剂-肌力性评分（18.0 vs 13.0, p = 0.021）、乳酸水平（9.1 vs 6.8, p = 0.017）、血液透析需求（22.9% vs 10.3%, p = 0.042）和48小时净体液平衡（10.6 vs 8.9升，p = 0.028）。气道并发症与较差的生存率（HR 2.74 [95% CI 1.35, 5.55], p = 0.004）和肺功能（1秒用力呼气峰值预测值分别为74.8%和86.3%,p = 0.013）相关。结论术后低血压和低灌注与肺移植术后气道并发症风险增加有关。气道并发症与不良预后相关，需要进一步的研究来确定风险缓解策略。
Airway complications after lung transplantation: Perioperative risk factors and clinical outcomes
Background
Airway complications after lung transplantation are common and contribute to worse outcomes. There are limited data documenting perioperative risk factors that could be mitigated to reduce risk. Our objectives were to (1) assess the impact of pretransplant disease–modifying medications and post-transplant hypotension, hypovolemia, and mechanical ventilation on the risk of airway complications; (2) evaluate the association of airway complications with post-transplant lung function and survival.
Methods
One hundred and forty-five bilateral lung transplant recipients at our center were included. Demographics, pretransplant medications, post-transplant intensive care unit variables, and lung function were compared between recipients who did vs did not develop airway complications. Post-transplant survival was estimated using Kaplan-Meier analysis.
Results
Forty-eight (33.1%) recipients (75% male) developed airway complications. There were no significant associations in pretransplant exposure to prednisone (including by dose), other immunosuppressants, or antifibrotics, alone or in any combination, with the development of airway complications. There were no differences in ventilation pressures, but recipients with airway complications had higher peak vasopressor-inotropic scores (18.0 vs 13.0, p = 0.021), lactate levels (9.1 vs 6.8, p = 0.017), need for hemodialysis (22.9% vs 10.3%, p = 0.042), and net fluid balance at 48 hours (10.6 vs 8.9 liters, p = 0.028), respectively, compared to those without. Airway complications were associated with significantly worse survival (HR 2.74 [95% CI 1.35, 5.55], p = 0.004) and lung function (peak forced expiratory value in 1 second 74.8% vs 86.3% predicted, respectively, p = 0.013).
Conclusions
Postoperative hypotension and hypoperfusion are associated with increased risk for airway complications after lung transplantation. Airway complications are associated with poor outcomes, and further studies are needed to delineate risk-mitigation strategies.
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