Malas Jad, Ranganath Neel K, Phillips Katherine G, Bittle Gregory J, Hisamoto Kazuhiro, Smith Deane E, Lesko Melissa B, Angel Luis F, Lonze Bonnie E, Kon Zachary N
Department of Cardiothoracic Surgery, Division of Cardiac Surgery, NYU Langone Health, New York, New York.
Department of Cardiothoracic Surgery, University of Maryland Medical Center, Baltimore, Maryland.
J Card Surg. 2019 Oct;34(10):933-940. doi: 10.1111/jocs.14157. Epub 2019 Jul 23.
Anastomotic complications occur in 7% to 18% of lung transplant recipients, among which airway dehiscence (AD) is particularly catastrophic. Using multi-institutional registry data, this study compared preoperative recipient/donor risk factors and outcomes in patients with and without AD and analyzed the effect of extracorporeal membrane oxygenation (ECMO) on the incidence of AD.
Data on adult lung transplants from 2007 to 2017 were provided by the Scientific Registry of Transplant Recipients. Patients receiving isolated lobar transplantation and patients with unknown AD status were excluded. Multivariable logistic regression identified independent risk factors for AD. Kaplan-Meier curves and log-rank tests describe mortality and graft survival.
Of 18 122 lung transplants, 275 (1.5%) experienced AD. While the incidence of ECMO steadily increased from 0.7% to 5.9% over the study period, the incidence of AD remained relatively constant. Multivariable analysis revealed recipient male gender and prolonged ( > 48 hours) posttransplant mechanical ventilation as independent predictive factors for AD, while advanced donor age and single left lung transplant were protective factors. Recipient chronic steroid use, recipient diabetes, donor diabetes, and donor smoking history were not predictive of AD. Mortality and graft failure were significantly worse in the AD group.
Despite increased ECMO utilization, the incidence of AD has remained stable. Multiple independent risk factors for AD were identified and poor postoperative outcomes confirmed. However, many known impediments to wound healing such as recipient chronic steroid use, recipient and donor diabetes, and donor smoking were not identified as risk factors for AD, reinforcing the critical role of technical performance.
肺移植受者中吻合口并发症的发生率为7%至18%，其中气道裂开（AD）尤为严重。本研究利用多机构登记数据，比较了发生和未发生AD的患者术前受者/供者的风险因素及预后，并分析了体外膜肺氧合（ECMO）对AD发生率的影响。
移植受者科学登记处提供了2007年至2017年成人肺移植的数据。排除接受单叶移植的患者及AD状态不明的患者。多变量逻辑回归确定了AD的独立危险因素。Kaplan-Meier曲线和对数秩检验描述了死亡率和移植物生存率。
在18122例肺移植中，275例（1.5%）发生了AD。在研究期间，虽然ECMO的使用率从0.7%稳步上升至5.9%，但AD的发生率保持相对稳定。多变量分析显示，受者男性性别和移植后机械通气时间延长（>48小时）是AD的独立预测因素，而供者年龄较大和左肺单叶移植是保护因素。受者长期使用类固醇、受者糖尿病、供者糖尿病和供者吸烟史不能预测AD。AD组的死亡率和移植物失败率明显更高。
尽管ECMO的使用增加，但AD的发生率保持稳定。确定了AD的多个独立危险因素，并证实了术后预后较差。然而，许多已知的伤口愈合障碍，如受者长期使用类固醇、受者和供者糖尿病以及供者吸烟，并未被确定为AD的危险因素，这进一步强调了技术操作的关键作用。
