Bronchial complications after lung transplantation are associated with primary lung graft dysfunction and surgical technique

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• 作者：Anne Olland ; MD ; MSc^a ; ^b ; ^{anne.olland@chru-strasbourg.fr} ; Jé ; ré ; mie Reeb ; MD ; MSc^a ; ^b ; Marc Puyraveau ; MSc^c ; Sandrine Hirschi ; MD^a ; Joseph Seitlinger ; MD^a ; Nicola Santelmo ; MD^a ; Olivier Collange ; MD ; PhD^d ; Paul-Michel Mertes ; MD ; PhD^d ; Romain Kessler ; MD ; PhD^a ; ^b ; Pierre-Emmanuel Falcoz ; MD ; PhD^a ; Gilbert Massard ; MD ; PhD^a ; ^b
• 关键词：lung transplantation ; bronchial healing ; anastomosis ; immunosuppressive regimen ; lung primary graft dysfunction ; lung graft infection
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：36
• 期：2
• 页码：157-165
• 全文大小：248 K
• 卷排序：36

文摘

After lung transplantation, bronchial complications are one of the major concerns for surgeons and physicians. In the era of evolving immunosuppressive regimens and surgical approaches, we have reassessed risk factors for bronchial complications after lung transplantation.MethodsWe undertook a retrospective study of all consecutive lung transplantations performed at a single center from 2004 to 2014. We monitored the incidence of symptomatic bronchial complications. Demographic data of donors and recipients were also studied. Our objective was to evaluate the impact of 3 subsequent immunosuppressive regimens (including the use of induction therapy), and of a technical modification of bronchial anastomosis on the incidence of airway complications.ResultsWe performed 270 consecutive lung transplantations during the study period. On multivariate analysis, bronchial complications were not directly associated with the different immunosuppressive regimens. In subgroup analysis, when comparing different immunosuppressive regimens, primary graft dysfunction within 72 hours (odds ratio [OR] = 2.55; p = 0.08), lung infection within the first month (OR = 2.96; p = 0.039), diabetes before transplantation (OR = 2.66; p = 0.11) and chronic obstructive pulmonary disease (OR = 2.20; p = 0.04) appeared as major risk factors (c-index = 0.77 on multivariate analysis). The use of a modified bronchial suture technique was associated with fewer bronchial complications (OR = 0.47; p = 0.059) (c-index = 0.71 on multivariate analysis).ConclusionsThe mode of immunosuppression had no influence on airway complications. We were able to reproduce the beneficial effect of a modified suture technique.