2006 - UZ Leuven

VAN DE WAUWER C., VAN RAEMDONCK D.E.M., VERLEDEN G.M.,DUPONT L., DE LEYN P., COOSEMANS W., NAFTEUX P., LERUT T.:Risk factors for airway complications within the first year after lungtransplantation. Interactive Cardiovasc. Thor. Surg., 2006; 5(2): S 218(132-0).Objectives: Lung transplantation (LTx) has enjoyed increasing succeswith better survival in recent years. Nevertheless, airway anastomoticcomplications (AC) are still a potential cause of early morbidity andmortality. In this retrospective study we looked at possible predictorsof AC within the first year after LTx.Methods: Between July 1991 and December 2004, 232 consecutivesingle (n=102) and bilateral (n=130) LTx were performed (142 malesand 90 females; mean age, 48 years (range 15-66 years)). Indicationsfor LTx were emphysema (n = 113), pulmonary fibrosis (n = 45), cysticfibrosis (n = 35), pulmonary hypertension (n = 10), sarcoidosis (n = 7)and miscellaneous (n = 22). Donor (age, PaO 2 /Fi0 2 , mechanicalventilation, ischaemic time) and recipient (age, diagnosis, length,gender, preop steroids, smoking, CMV matching, LTx type,anastomotic type, wrapping and bypass) variables were evaluated in aunivariate and multivariate model.Results: Fifty-seven complications occurred in 362 airwayanastomoses (15.7%) of which 55 (15.2%) within the first year aftertransplantation. Six patients died as a result of AC (mortality 2.6%)and 191 patients survived the first year after LTx (321 airwayanastomoses). In a univariate analysis, anastomotic type (7/17(telescoping) vs. 48/304 (end-to-end); P = 0.011), recipient length (P =0.0012), donor ventilation (> 50-70 h; P = 0.0015) and recipient malegender (43/191 (M) vs. 12/130 (F); P = 0.0092) were significantpredictors of AC. Three factors remained significant predictors in themultivariate analysis: telescoping (OR: 3.121; P = 0.0495), recipientlength (OR: 1.065; P = 0.0029) and donor ventilation (OR = 0.999; P =0.0029).Conclusions: Airway complications after lung transplantation remain asignificant problem. Special surgical attention is needed in tallrecipients and in those receiving lungs from donors with prolongedventilation.VAN RAEMDONCK D., VERLEDEN G.M., DUPONT L., DELCROIX M.,DAENEN W., VANHAECKE J., COOSEMANS W., DECKER G., DE LEYNP., NAFTEUX P., LERUT T. en de Leuvense Longtransplantatiegroep.Longtransplantaties in de U.Z. Leuven. Deel I: Klinisch programma:ervaring met 260 (hart-)longtransplantaties. Tijdschr. voor Geneeskunde,2006; 62(7): 516-524.115