PURPOSE:Although airway stenosis commonly complicates human lung transplant recipients, the specific risk factors for airway complications requiring intervention after lung transplantation have not been well described. The purpose of our study was to characterize the incidence, range of complications, and risk factors for airway stenosis that occurs within the first year in a large single center cohort of lung transplant recipients.
METHODS:We retrospectively reviewed the records of all adult cadaveric lung transplants occurring at our center between May 22, 2003 and February 3, 2007 (n=216). Patients with airway complications requiring dilation and/or stenting of an airway within the first year after transplant (n=33) were compared with those without airway complications (n=183). Patients undergoing retransplant were excluded.
RESULTS:Among the 216 patients, all underwent bilateral lung transplant. Native diseases included, obstructive airway disease(n=83 or 38.4%), interstitial disease (n=72 or 33.3%), cystic fibrosis(n=41 or 9.0%), sarcoidosis (n=11 or 5.1%), pulmonary hypertension(n=5 or 2.3%), or miscellaneous diseases (n= 4 or 1.9%). 15.3%(n=33) developed an airway complication resulting in dilation and/or stenting of an airway. Cystic fibrosis appeared to be a protective against airway complications as there were no cystic fibrosis patients who required airway intervention (OR=0.051, 95% CI: 0.003–0.855, p=0.0011). In addition, of all transplanted patients, 154 (71.3%) developed an episode of acute rejection within the first year after transplant. Patients with an airway complication requiring intervention had a significantly earlier onset of acute rejection as compared to those without airways complications (49.3 days ± 7.4 vs. 71.1 days ± 7.3, respectively, 95% CI: 1.13–42.46, p=0.0387).
CONCLUSION:Airway complications requiring intervention after lung transplant are relatively common and occurred in approximately 15% of patients in this cohort. A native disease of cystic fibrosis appears to be protective against airway complications whereas early acute rejection is associated with an increased risk.
CLINICAL IMPLICATIONS:Additional multicenter studies are needed to validate these observations and develop better strategies to prevent the development of posttransplant airway complications.
DISCLOSURE:Erika Lease, No Financial Disclosure Information; No Product/Research Disclosure Information