Kapnadak Siddhartha G, Ramos Kathleen J, Flodin Rachel, Mansoor Sanaa, Bilodeau Kyle, Beidler Peter, Lease Erika D, Thomas Ryan, Dubois Richard, Pal Jay, Mulligan Michael S
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington.
Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Washington.
JHLT Open. 2025 Jun 6;9:100315. doi: 10.1016/j.jhlto.2025.100315. eCollection 2025 Aug.
Airway complications after lung transplantation are common and contribute to worse outcomes. There are limited data documenting perioperative risk factors that could be mitigated to reduce risk. Our objectives were to (1) assess the impact of pretransplant 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.
One hundred and forty-five bilateral lung transplant recipients at our center were included. Demographics, pretransplant medications, post-transplant intensive care unit variables, and lung function were compared between recipients who did vs did not develop airway complications. Post-transplant survival was estimated using Kaplan-Meier analysis.
Forty-eight (33.1%) recipients (75% male) developed airway complications. There were no significant associations in pretransplant 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, = 0.021), lactate levels (9.1 vs 6.8, = 0.017), need for hemodialysis (22.9% vs 10.3%, = 0.042), and net fluid balance at 48 hours (10.6 vs 8.9 liters, = 0.028), respectively, compared to those without. Airway complications were associated with significantly worse survival (HR 2.74 [95% CI 1.35, 5.55], = 0.004) and lung function (peak forced expiratory value in 1 second 74.8% vs 86.3% predicted, respectively, = 0.013).
Postoperative 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.
肺移植术后气道并发症很常见，会导致更差的预后。记录可减轻以降低风险的围手术期危险因素的数据有限。我们的目标是：（1）评估移植前疾病改善药物以及移植后低血压、低血容量和机械通气对气道并发症风险的影响；（2）评估气道并发症与移植后肺功能及生存率的关联。
纳入我们中心的145例双侧肺移植受者。比较发生气道并发症与未发生气道并发症的受者的人口统计学、移植前用药、移植后重症监护病房变量及肺功能。采用Kaplan-Meier分析估计移植后的生存率。
48例（33.1%）受者（75%为男性）发生气道并发症。移植前单独或联合使用泼尼松（包括按剂量）、其他免疫抑制剂或抗纤维化药物与气道并发症的发生无显著关联。通气压力无差异，但发生气道并发症的受者与未发生气道并发症的受者相比，血管活性药物峰值评分更高（18.0对13.0，P = 0.021）、乳酸水平更高（9.1对6.8，P = 0.017）、需要血液透析的比例更高（22.9%对10.3%，P = 0.042），48小时时的净液体平衡更高（10.6对8.9升，P = 0.028）。气道并发症与显著更差的生存率（风险比2.74 [95%置信区间1.35，5.55]，P = 0.004）和肺功能（第1秒用力呼气峰值分别为预测值的74.8%对86.3%，P = 0.013）相关。
术后低血压和低灌注与肺移植术后气道并发症风险增加相关。气道并发症与不良预后相关，需要进一步研究以确定风险减轻策略。
