Dysphagia in Lung Transplant Recipients: Prevalence, Risk Factors and Health-Related Outcomes

Abstract

Purpose Although lung transplantation (LT) remains the definitive therapy for end-stage respiratory disease, limited long-term survival rates highlight the need for improved post-transplant care. Given the high risk for postoperative dysphagia, we aimed to determine the prevalence, risk factors and associated outcomes of dysphagia in postoperative LT patients. Methods A retrospective review of consecutive adult patients undergoing LT and postoperative videofluoroscopic evaluation of swallowing (VFSS) at our institution between 11/2017 and 6/2020 was conducted. Relevant outcomes were extracted from electronic medical records (EPIC) and entered into a central database (REDCap). VFSS notes were examined and Penetration Aspiration Scale (PAS) scores extracted. Descriptives, t-tests, one-way ANOVA's, chi-squares and odds ratios were derived in SPSS. Results 205 LT recipients met inclusion criteria and were included. Mean age was 58.63 years and 50.7% were male. Postoperatively, 18% demonstrated safe swallowing (n=37), 39% demonstrated laryngeal penetration (n=79), and 43% demonstrated tracheal aspiration (n=89). Aspiration response profiles included: 50% no cough response (n=41), 31.7% ejection of aspirate material (n=26), and 18.3% ineffective cough response (n=15). Postoperative aspiration in LT patients was associated with: 1) peri-transplant venous-venous extracorporeal membrane oxygenation (OR: 2.0, X2 =3.7, p=.05); 2) cardiopulmonary bypass (n=40; OR: 2.3, X2=5.7, p=.02); 3) ≥ 3 intubations (OR: 7.5, X2 =5.2, p=.02); 4) tracheostomy (OR: 4.8, X2 =8.3, p=.004); and 4) longer intubation duration (70 vs. 44 hours, p=.002). LT patients who aspirated waited an average of 240 hours longer to resume a regular diet (p=0.004) and demonstrated a 2.4 and 2.0 higher odds of pneumonia and discharge to a acute rehab, respectively. One-year mortality rate was 2.9% (n=6), with 100% of deaths classified as unsafe swallowers. Conclusion Dysphagia was highly prevalent and associated with inferior patient outcomes. The observation that ∼70% of aspirators could not clear tracheal aspirate may explain, in part, the increased odds for development of pneumonia. Mortality data suggest that presence of dysphagia may impact survival and should be further examined in ongoing prospective studies.