Service de Pneumologie, L'institut du thorax, Boulevard Jacques Monod, CHU Nantes, hôpital G. et R. Laennec, 44 093 Nantes cedex 1, France.
Current address: Service de Réanimation polyvalente, Centre Hospitalier Bretagne Atlantique, 20, Boulevard du Général Maurice Guillaudot, 56 017 Vannes Cedex, France.
Ther Adv Respir Dis. 2022 Jan-Dec;16:17534666221110354. doi: 10.1177/17534666221110354.
Anastomotic complications are common after lung transplantation (1.4-33% of cases) and still associated with a high morbi-mortality.
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.
A total of 121 patients were included. SAC occurred in 26.5% of patients ( = 32), divided in symptomatic stenosis for 23.7% ( = 29), and symptomatic dehiscence in 2.5% ( = 3). In multivariate analysis, donor bacterial lung infection [HR 2.08 (1.04-4.17), = 0.04] and age above 50 years [HR 3.26 (1.04-10.26), = 0.04] were associated with SAC occurrence. Cystic fibrosis etiology was associated with better survival on Kaplan-Meier curve ( < 0.001). SAC [HR 2.15 (1.07-4.32), = 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).
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.
肺移植术后吻合口并发症很常见（1.4-33%的病例），仍然与高死亡率相关。
本研究是一项单中心回顾性分析，纳入了 2010 年至 2016 年期间发生的肺移植后有症状吻合口并发症（SAC）的患者，使用法国支气管镜专家共识的宏观、直径和缝线（M-D-S）分类。目的是确定手术时的发生率、危险因素和 SAC 对生存率的影响。我们将 SAC 定义为需要支气管镜或手术干预的 M-D-S 异常（狭窄 ⩾ 50%或裂开）。
共纳入 121 例患者。26.5%的患者（32 例）发生 SAC，其中 23.7%（29 例）为有症状性狭窄，2.5%（3 例）为有症状性裂开。多变量分析显示，供体细菌肺部感染[HR 2.08（1.04-4.17），=0.04]和年龄 ⩾50 岁[HR 3.26（1.04-10.26），=0.04]与 SAC 发生相关。囊性纤维化病因与 Kaplan-Meier 曲线上的更好生存率相关（ ⩽0.001）。SAC [HR 2.15（1.07-4.32），=0.03]与最差生存率独立相关。29 例因狭窄而出现症状的患者需要进行内镜检查，其中 16 例需要放置支气管支架。4 例患者接受了手术：3 例因裂开，1 例因严重双侧狭窄（再次移植）。
26.5%的患者发生了 SAC。供体肺部感染是唯一可改变的危险因素。50 岁以上老年患者 SAC 发生率增加，鼓励定期进行内镜监测。
