Airway complications after lung transplantation: Contemporary survival and outcomes

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:35

Article

Hayanga, J. W. Awori¹  Aboagye, Jonathan K.²  Shigemura, Norihisa¹  Hayanga, Heather K.¹  Murphy, Edward³  Khaghani, Asghar³  D'Cunha, Jonathan¹ 

[1] Univ Pittsburgh, Med Ctr, Dept Cardiothorac Surg, 200 Lothrop St, Pittsburgh, PA 15213 USA

[2] Johns Hopkins Med Inst, Dept Surg, Baltimore, MD 21205 USA

[3] Spectrum Hlth Syst, DeVos Heart & Lung Transplantat Program, Grand Rapids, MI USA

关键词: airway complications;    lung transplantation;    survival;    lung allocation score;    outcomes;    predictors;    contemporary;   

DOI  :  10.1016/j.healun.2016.04.019

来源: Elsevier

【 摘 要 】

BACKGROUND: Airway complications are rare and cause increased morbidity and mortality after lung transplantation (LT). We sought to examine risk factors associated with this complication and its impact on survival. METHODS: We retrospectively evaluated United Network for Organ Sharing data from 2000 to 2012. A backward stepwise logistic regression was performed on recipient-, donor-, and transplant-related variables to select independent risk factors associated with airway complications and mortality. Survival was evaluated using the Kaplan-Meier method. RESULTS: We evaluated 16,156 consecutive adult LT recipients, among whom 233 (1.4%) developed airway complications. Predictors of increased risk of airway complications included male gender (odds ratio [OR] 1.61, p = 0.001), advancing recipient age (OR 1.02, p < 0.001) and pre-transplantation admission to the intensive care unit (ICU) (OR 2.13, p < 0.001). The 30-day (89.6% vs 96.2%, p = 0.001), 90-day (69.9% vs 93.1%, p < 0.001), 1-year (54.6% vs 84.4%, p < 0.001), 3-year (38.7% vs 67.4%, p < 0.001) and 5-year (33.2% vs 54.2%, p < 0.001) survival rates were each significantly reduced in recipients with airway complications. Factors associated with an increased risk of 1-year mortality included recipient age (hazard ratio [HR] 1.01, p < 0.001), use of extracorporeal mechanical support (HR 1.5, p = 0.01), diagnosis of cystic fibrosis (HR 1.22, p = 0.01), glomerular filtration rate (GFR) 60 to 90 ml/min/1.73 m(2) (HR 1.61, p < 0.001), GFR <60 ml/min/1.73 m(2) (HR 1.13, p = 0.01), non-ICU hospitalization (HR 1.32, p < 0.001), pre-transplantation ICU hospitalization (HR 2.54, p < 0.001), donor with positive serology for cytomegalovirus (HR 1.16, p < 0.001) and donor with a smoking history (HR 1.19, p < 0.001). Double LT (HR 0.83, p < 0.001) was associated with a decreased risk of death. Chronic obstructive pulmonary disease/emphysema was protective compared with idiopathic pulmonary fibrosis (HR 0.85, p = 0.008). CONCLUSION: Airway complications are associated with a significant mortality burden. (C) 2016 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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