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132: Airway Complications after Lung Transplantation: Incidence and Risk Factors in a Contemporary Series
The Journal of Heart and Lung Transplantation Volume 27, Number 2S
has occurred in 18/312 patients (5.7%) since the year 2000; 10 patients (3.2%) required dilatation, 3 (0.9%) required stent insertion, 2 (0.6%) had dehiscence treated conservatively, and 3 (0.9%) died from bronchial complications. Only 2 patients developed bronchial complications without severe PGD since the year 2000. 5-year survival was 55% and was not affected by the occurrence of bronchial complication. Conclusions: This large series of LT performed at one center with a similar anastomotic technique demonstrates that the incidence of bronchial complications after LT is low and has improved over the last decade. Primary graft dysfunction requiring prolonged mechanical ventilation remains the major risk factor for airway complication.
132 Airway Complications after Lung Transplantation: Incidence and Risk Factors in a Contemporary Series R.R. Hachem,1 B.F. Meyers,2 R.D. Yusen,1 A. Patterson,2 E.P. Trulock,1 1Pulmonary & Critical Care, Washington University School of Medicine, St. Louis, MO; 2Thoracic Surgery, Washington University School of Medicine, St. Louis, MO Purpose: The purpose of this study was to characterize the spectrum of airway complications after lung transplantation in our program and to identify potential risk factors. Methods and Materials: We retrospectively evaluated clinical data for all adult lung transplant recipients at our program between 1/2003 and 12/2006 (n⫽217). All patients underwent routine surveillance bronchoscopies. We defined an airway complication as one that required a therapeutic intervention. We then evaluated baseline characteristics and early post-transplant outcomes to identify potential risk factors for airway complications using multivariate logistic regression. Results: Among the 217 recipients, 34 (15.6%) developed an airway complication. These included stricture (n⫽14), mucosal necrosis (n⫽10), dehiscence (n⫽8), and malacia (n⫽2). Our therapeutic strategy consisted of debridement and dilation as necessary, but 8 patients required stent implantation. All patients who had a stent placed had recurrent problems with stent migration or mucoid impaction. Ultimately, 3 required sleeve resection and 2 required re-transplantation. Univariate logistic regression identified donor gender, donor height, recipient gender, the use of cardiopulmonary bypass, and PGD grade 3 as potential risk factors for airway complications (p⬍0.1). However, diagnosis, operation performed, recipient height and age, positive donor or recipient airway cultures, and PGD grades 1 and 2 were not significant risk factors. In the multivariate model, PGD grade 3 was the only significant risk factor (OR⫽3.4, 95%CI: 1.1-10.3, p⫽0.03); the use of cardiopulmonary bypass was associated with a trend to an increased risk but this was not statistically significant (OR⫽2.8, 95%CI: 0.9-8.5, p⫽0.06). Conclusions: Approximately 15% of recipients in this cohort developed airway complications and these often resulted in significant morbidity. PGD grade 3 is associated with a significantly increased risk of airway complications.
133 Increased BAL Neutrophilia on Routine Bronchoscopy 3 or 6 Months after Lung Transplantation Is a Significant Predictor of BOS L.J. Dupont,1 B.M. Vanaudenaerde,1 R. Vos,1 D.E. Van Raemdonck,1 G.M. Verleden,1 1Leuven Lung Transplant Team, University Hospital Gasthuisberg, Leuven, Belgium
Abstracts
S107
Purpose: A prospective cohort study was performed to evaluate whether BAL differential cell count obtained early after LTX may predict the occurence of BOS. Methods and Materials: 73 pts transplanted between 7/2002 and 6/2004 at our institution underwent routine bronchoscopy with BAL at 1, 3 and 6 months after LTx. For BAL, two aliquots of sterile 50 mL saline were instilled in the right middle lobe or lingula. The returned fractions were pooled and used for analysis. Follow-up was completed for a period of at least 3 years in every patient, or untill death or retransplantation occurred. BAL samples obtained during infection or an episode of acute rejection grade Aⱖ2 were not used for analysis. Results: In 17 pts the development of BOS could not be assessed (premature death, anastomotic stricture, ..) or BAL was not obtained. During follow-up, 23 pts (7 SLTx, 16 SSLTx) were diagnosed with BOS 1 at 620⫾70 days after LTx. The remaining 33 pts (10 SLTx, 20 SSLTx, 3 HLTx) were labeled as free of BOS ⱖ1 for ⬎3 years after LTx. BAL neutrophilia at 3 and 6 mo, but not at 1 mo was significantly increased in those pts that developed BOS vs. those that did not (at 3 mo 19.8⫾5.3% versus 6.9⫾1.7% BAL neutrophils, respectively (p⫽0.03) and at 6 mo 23.0⫾5.8% versus 4.9⫾1.4% BAL neutrophils, respectively (p⬍0.01)). At 3 mo, BAL IL-8 was also significantly increased (115.2 ⫾26.7pg/ml versus 52.8⫾12.9pg/ml respectively p⫽0.04). Subjects who had a BAL neutrophilia ⬎ 10% either at 3 or at 6 mo after LTx were more likely to develop BOS 1 (log rank p⫽0.003, Kaplan-Meier method). Conclusions: BAL neutrophilia at 3 or 6 months after LTx predisposes to the development of BOS.
134 Current Results for Lung Transplantation in Children O. Elidemir,1 M.G. Schecter,1 J.S. Heinle,2 D.L. Morales,2 E.D. McKenzie,2 J.M. Robertson,1 G.B. Mallory,1 1Pediatric Pulmonology, Baylor College of Medicine, Houston, TX; 2 Congenital Heart Surgery, Baylor College of Medicine, Houston, TX Purpose: Certain issues such as size, primary diagnosis and nonadherence to therapy complicate lung transplantation in the pediatric population. The purpose of this study is to investigate the short and long term outcomes of lung transplantation in children. Methods and Materials: Retrospective chart review of a single center. Results: A total of 61 lung transplants were performed: 47 bilateral lung, 10 en-bloc lungs with bronchial artery revascularization, 2 heart-lungs and 2 liver-lungs. Mean age was 11.7 years (range: 2 mo-21 yrs). Male/female ratio was 28/33. There were 45 Caucasian (74%), 10
has occurred in 18/312 patients (5.7%) since the year 2000; 10 patients (3.2%) required dilatation, 3 (0.9%) required stent insertion, 2 (0.6%) had dehiscence treated conservatively, and 3 (0.9%) died from bronchial complications. Only 2 patients developed bronchial complications without severe PGD since the year 2000. 5-year survival was 55% and was not affected by the occurrence of bronchial complication. Conclusions: This large series of LT performed at one center with a similar anastomotic technique demonstrates that the incidence of bronchial complications after LT is low and has improved over the last decade. Primary graft dysfunction requiring prolonged mechanical ventilation remains the major risk factor for airway complication.
132 Airway Complications after Lung Transplantation: Incidence and Risk Factors in a Contemporary Series R.R. Hachem,1 B.F. Meyers,2 R.D. Yusen,1 A. Patterson,2 E.P. Trulock,1 1Pulmonary & Critical Care, Washington University School of Medicine, St. Louis, MO; 2Thoracic Surgery, Washington University School of Medicine, St. Louis, MO Purpose: The purpose of this study was to characterize the spectrum of airway complications after lung transplantation in our program and to identify potential risk factors. Methods and Materials: We retrospectively evaluated clinical data for all adult lung transplant recipients at our program between 1/2003 and 12/2006 (n⫽217). All patients underwent routine surveillance bronchoscopies. We defined an airway complication as one that required a therapeutic intervention. We then evaluated baseline characteristics and early post-transplant outcomes to identify potential risk factors for airway complications using multivariate logistic regression. Results: Among the 217 recipients, 34 (15.6%) developed an airway complication. These included stricture (n⫽14), mucosal necrosis (n⫽10), dehiscence (n⫽8), and malacia (n⫽2). Our therapeutic strategy consisted of debridement and dilation as necessary, but 8 patients required stent implantation. All patients who had a stent placed had recurrent problems with stent migration or mucoid impaction. Ultimately, 3 required sleeve resection and 2 required re-transplantation. Univariate logistic regression identified donor gender, donor height, recipient gender, the use of cardiopulmonary bypass, and PGD grade 3 as potential risk factors for airway complications (p⬍0.1). However, diagnosis, operation performed, recipient height and age, positive donor or recipient airway cultures, and PGD grades 1 and 2 were not significant risk factors. In the multivariate model, PGD grade 3 was the only significant risk factor (OR⫽3.4, 95%CI: 1.1-10.3, p⫽0.03); the use of cardiopulmonary bypass was associated with a trend to an increased risk but this was not statistically significant (OR⫽2.8, 95%CI: 0.9-8.5, p⫽0.06). Conclusions: Approximately 15% of recipients in this cohort developed airway complications and these often resulted in significant morbidity. PGD grade 3 is associated with a significantly increased risk of airway complications.
133 Increased BAL Neutrophilia on Routine Bronchoscopy 3 or 6 Months after Lung Transplantation Is a Significant Predictor of BOS L.J. Dupont,1 B.M. Vanaudenaerde,1 R. Vos,1 D.E. Van Raemdonck,1 G.M. Verleden,1 1Leuven Lung Transplant Team, University Hospital Gasthuisberg, Leuven, Belgium
Abstracts
S107
Purpose: A prospective cohort study was performed to evaluate whether BAL differential cell count obtained early after LTX may predict the occurence of BOS. Methods and Materials: 73 pts transplanted between 7/2002 and 6/2004 at our institution underwent routine bronchoscopy with BAL at 1, 3 and 6 months after LTx. For BAL, two aliquots of sterile 50 mL saline were instilled in the right middle lobe or lingula. The returned fractions were pooled and used for analysis. Follow-up was completed for a period of at least 3 years in every patient, or untill death or retransplantation occurred. BAL samples obtained during infection or an episode of acute rejection grade Aⱖ2 were not used for analysis. Results: In 17 pts the development of BOS could not be assessed (premature death, anastomotic stricture, ..) or BAL was not obtained. During follow-up, 23 pts (7 SLTx, 16 SSLTx) were diagnosed with BOS 1 at 620⫾70 days after LTx. The remaining 33 pts (10 SLTx, 20 SSLTx, 3 HLTx) were labeled as free of BOS ⱖ1 for ⬎3 years after LTx. BAL neutrophilia at 3 and 6 mo, but not at 1 mo was significantly increased in those pts that developed BOS vs. those that did not (at 3 mo 19.8⫾5.3% versus 6.9⫾1.7% BAL neutrophils, respectively (p⫽0.03) and at 6 mo 23.0⫾5.8% versus 4.9⫾1.4% BAL neutrophils, respectively (p⬍0.01)). At 3 mo, BAL IL-8 was also significantly increased (115.2 ⫾26.7pg/ml versus 52.8⫾12.9pg/ml respectively p⫽0.04). Subjects who had a BAL neutrophilia ⬎ 10% either at 3 or at 6 mo after LTx were more likely to develop BOS 1 (log rank p⫽0.003, Kaplan-Meier method). Conclusions: BAL neutrophilia at 3 or 6 months after LTx predisposes to the development of BOS.
134 Current Results for Lung Transplantation in Children O. Elidemir,1 M.G. Schecter,1 J.S. Heinle,2 D.L. Morales,2 E.D. McKenzie,2 J.M. Robertson,1 G.B. Mallory,1 1Pediatric Pulmonology, Baylor College of Medicine, Houston, TX; 2 Congenital Heart Surgery, Baylor College of Medicine, Houston, TX Purpose: Certain issues such as size, primary diagnosis and nonadherence to therapy complicate lung transplantation in the pediatric population. The purpose of this study is to investigate the short and long term outcomes of lung transplantation in children. Methods and Materials: Retrospective chart review of a single center. Results: A total of 61 lung transplants were performed: 47 bilateral lung, 10 en-bloc lungs with bronchial artery revascularization, 2 heart-lungs and 2 liver-lungs. Mean age was 11.7 years (range: 2 mo-21 yrs). Male/female ratio was 28/33. There were 45 Caucasian (74%), 10