Work

Airway complications after lung transplantation: Perioperative risk factors and clinical outcomes

Year: 2025

Type: article

Abstract: Background Airway complications after lung transplantation are common and contribute to worse outcomes. There are limited data documenting peri-operative risk factors that could be mitigated to reduce risk. Our objectives were to: 1) Assess the impact of pre-transplant 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 forty-five bilateral lung transplant recipients at our center were included. Demographics, pre-transplant medications, post-transplant intensive care unit variables, and lung function were compared between recipients who did versus 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 pre-transplant 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 48hrs (10.6L vs 8.9L, p=0.028), respectively, compared to those without. Airway complications were associated with significantly worse survival (HR 2.74 [1.35, 5.55]) and lung function (peak FEV 1 74.8% versus 86.3% predicted, respectively, p=0.013). Conclusions Post-operative 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.

Source: JHLT Open

DOI: 10.1016/j.jhlto.2025.100315