Airway complications after lung transplantation: Perioperative risk factors and clinical outcomes
Background: 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 a...
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Elsevier
2025-08-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133425001107 |
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| author | Siddhartha G. Kapnadak, MD Kathleen J. Ramos, MD, MS Rachel Flodin, MS Sanaa Mansoor, MD Kyle Bilodeau, MD Peter Beidler, BS Erika D. Lease, MD Ryan Thomas, BS Richard Dubois, MD Jay Pal, MD, PhD Michael S. Mulligan, MD |
| author_facet | Siddhartha G. Kapnadak, MD Kathleen J. Ramos, MD, MS Rachel Flodin, MS Sanaa Mansoor, MD Kyle Bilodeau, MD Peter Beidler, BS Erika D. Lease, MD Ryan Thomas, BS Richard Dubois, MD Jay Pal, MD, PhD Michael S. Mulligan, MD |
| author_sort | Siddhartha G. Kapnadak, MD |
| collection | DOAJ |
| description | Background: 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. Methods: 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. Results: 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, 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 48 hours (10.6 vs 8.9 liters, p = 0.028), respectively, compared to those without. Airway complications were associated with significantly worse survival (HR 2.74 [95% CI 1.35, 5.55], p = 0.004) and lung function (peak forced expiratory value in 1 second 74.8% vs 86.3% predicted, respectively, p = 0.013). Conclusions: 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. |
| format | Article |
| id | doaj-art-5773b11c46d94e3ca2b16f0c35a35538 |
| institution | Matheson Library |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
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| series | JHLT Open |
| spelling | doaj-art-5773b11c46d94e3ca2b16f0c35a355382025-06-25T04:52:56ZengElsevierJHLT Open2950-13342025-08-019100315Airway complications after lung transplantation: Perioperative risk factors and clinical outcomesSiddhartha G. Kapnadak, MD0Kathleen J. Ramos, MD, MS1Rachel Flodin, MS2Sanaa Mansoor, MD3Kyle Bilodeau, MD4Peter Beidler, BS5Erika D. Lease, MD6Ryan Thomas, BS7Richard Dubois, MD8Jay Pal, MD, PhD9Michael S. Mulligan, MD10Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington; Corresponding author: Siddhartha G. Kapnadak, MD, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, 1959 NE Pacific Street, Box 356522, Seattle, WA 98195.Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WashingtonDivision of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WashingtonDivision of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WashingtonDivision of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WashingtonDivision of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WashingtonDivision of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WashingtonDivision of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WashingtonDivision of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WashingtonDivision of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WashingtonDivision of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, WashingtonBackground: 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. Methods: 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. Results: 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, 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 48 hours (10.6 vs 8.9 liters, p = 0.028), respectively, compared to those without. Airway complications were associated with significantly worse survival (HR 2.74 [95% CI 1.35, 5.55], p = 0.004) and lung function (peak forced expiratory value in 1 second 74.8% vs 86.3% predicted, respectively, p = 0.013). Conclusions: 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.http://www.sciencedirect.com/science/article/pii/S2950133425001107lung transplantationairway complicationsantifibroticsimmunosuppressantsintensive care unit |
| spellingShingle | Siddhartha G. Kapnadak, MD Kathleen J. Ramos, MD, MS Rachel Flodin, MS Sanaa Mansoor, MD Kyle Bilodeau, MD Peter Beidler, BS Erika D. Lease, MD Ryan Thomas, BS Richard Dubois, MD Jay Pal, MD, PhD Michael S. Mulligan, MD Airway complications after lung transplantation: Perioperative risk factors and clinical outcomes JHLT Open lung transplantation airway complications antifibrotics immunosuppressants intensive care unit |
| title | Airway complications after lung transplantation: Perioperative risk factors and clinical outcomes |
| title_full | Airway complications after lung transplantation: Perioperative risk factors and clinical outcomes |
| title_fullStr | Airway complications after lung transplantation: Perioperative risk factors and clinical outcomes |
| title_full_unstemmed | Airway complications after lung transplantation: Perioperative risk factors and clinical outcomes |
| title_short | Airway complications after lung transplantation: Perioperative risk factors and clinical outcomes |
| title_sort | airway complications after lung transplantation perioperative risk factors and clinical outcomes |
| topic | lung transplantation airway complications antifibrotics immunosuppressants intensive care unit |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425001107 |
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