Risk Factors Associated with Airway Complications after Lung Transplantation

Purpose This study aimed to classify and grade airway complications after lung transplant and to evaluate the risk of airway complications associated with antifibrotic use at a single lung transplant center. Methods All cases of lung transplantation at Barnes-Jewish Hospital between 1/1/2015 and 5/31/2018 were reviewed. Airway complications were graded using the 2018 ISHLT Consensus Statement on Adult Anastomotic Airway Complications. Antifibrotic use within 2 weeks of transplant was evaluated for association with airway complications by logistic regression. Results Based on the ISHLT Consensus definition, 159/261 patients (60.9%) had an airway complication; among these, only 20 (7.6%) were considered severe. There was no association between diagnosis for transplant and the development of an airway complication. AF use was associated with severe ischemic airway complication; among 58 who were on an AF agent pre-transplant, 8 (13.8%) developed an airway complication after transplant (odds ratio [OR] 2.547; 95% confidence interval [CI], 0.988 to 6.567; p = 0.053). This association was significant for nintedanib (OR 3.767; 95% CI, 1.119 to 12.681; p = 0.032) but not pirfenidone (OR 1.471; 95% CI, 0.465 to 4.660; p = 0.511). AF use was also associated with development of anastomotic stenosis; 14/58 (24.1%) developed anastomotic stenosis (OR 2.074; 95% CI, 1.004 to 4.283; p = 0.049). This association was not significant for nintedanib (OR 2.044; 95% CI, 0.693 to 6.022; p = 0.195) or pirfenidone (OR 1.781; 95% CI, 0.774 to 4.100; p = 0.175). AF use was not associated with anastomotic dehiscence; 8/58 (13.8%) developed a dehiscence (OR 1.139; 95% CI, 0.484 to 2.681; p = 0.765). Conclusion The grading system proposed by the 2018 ISHLT Consensus Statement led to identification of airway complication in >60% of lung transplants in this cohort, but most were considered mild and did not require intervention. Antifibrotic use was associated with increased risk of severe ischemic airway complications and anastomotic stenosis.