Therapeutic Advances in Respiratory Disease (Jul 2022)

Incidence and risk factors of anastomotic complications after lung transplantation

  • Agathe Delbove,
  • Thomas Senage,
  • Pierre Gazengel,
  • Adrien Tissot,
  • Philippe Lacoste,
  • Laurent Cellerin,
  • Christian Perigaud,
  • Isabelle Danner-Boucher,
  • Arnaud Cavailles,
  • Thierry Lepoivre,
  • Antoine Mugniot,
  • Johanna Nicolet,
  • Delphine Horeau-Langlard,
  • Nicolas Groleau,
  • Yannick Fedun,
  • Bertrand Rozec,
  • Antoine Magnan,
  • Jean-Christian Roussel,
  • François-Xavier Blanc

DOI
https://doi.org/10.1177/17534666221110354
Journal volume & issue
Vol. 16

Abstract

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Background: Anastomotic complications are common after lung transplantation (1.4–33% of cases) and still associated with a high morbi-mortality. Methods: The current study is a monocenter retrospective analysis of symptomatic anastomotic complications (SAC) occurring after lung transplantation between 2010 and 2016, using the macroscopic, diameter, and suture (M-D-S) classification from consensus of French experts in bronchoscopy. The objectives were to determine incidence from surgery, risk factors, and impact of survival of SAC. We defined SAC as M-D-S abnormalities (stenosis ⩾ 50% or dehiscence) requiring bronchoscopic or surgical interventions. Results: A total of 121 patients were included. SAC occurred in 26.5% of patients ( n = 32), divided in symptomatic stenosis for 23.7% ( n = 29), and symptomatic dehiscence in 2.5% ( n = 3). In multivariate analysis, donor bacterial lung infection [HR 2.08 (1.04–4.17), p = 0.04] and age above 50 years [HR 3.26 (1.04–10.26), p = 0.04] were associated with SAC occurrence. Cystic fibrosis etiology was associated with better survival on Kaplan–Meier curve ( p < 0.001). SAC [HR 2.15 (1.07–4.32), p = 0.03] was independently associated with worst survival. The 29 symptomatic patients because of stenosis required endoscopic procedure, of whom 16 patients needed bronchial stent placement. Four patients underwent surgery: three patients because of dehiscence and one because of severe bilateral stenosis (re-transplantation). Discussion: SAC occurred in 26.5% of patients. Donor lung infection was the only alterable identified factors. The increase rate of SAC in older patients above 50 years of age encourages in regular endoscopic monitoring.