Predictors and Outcomes among Patients with Early Swallow Dysfunction after Lung Transplantation

Abstract

To evaluate the patient characteristics, associated variables and early and late outcomes among patients with swallow dysfunction on modified barium swallow study (MBSS) after lung transplantation (LT). This was a retrospective study that included patients transplanted between 2012- 2015 (n=257, mean age 58±13 years, M:F 165: 92). We reviewed baseline characteristics, and findings on MBSS done as part of the post-transplant assessment of swallow function. We also reviewed the pre and post LT course including morbidity and mortality endpoints. A completely normal swallow evaluation on MBSS was unusual (n=60, 23.3%) with laryngeal penetration as the most commonly encountered abnormality (n=187, 72.8%) following by oropharyngeal pooling of secretions (n=72, 28%). Aspiration was noted in nearly one-fifth of the study group (50/257). Baseline demographics, co-morbidities, underlying diagnosis, or LAS were not associated with aspiration on post-LT MBSS. Patients bridged to transplant on mechanical ventilation (42.9% vs 17.4%; OR: 3.6, 1.4-9; p=0.005) had increased risk of aspiration. None of the post-operative variables such as primary graft dysfunction, duration of intubation after LT, ICU or hospital length of stay were associated with aspiration. Although patients with aspiration had worse one-yr (16% vs 5.8%; OR,95%CI: 3.1, 1.19-8.06; p=0.016, see Figure) and possibly 3-yr mortality (36% vs 23.7%; OR,95%CI: 1.8, 0.94-1.19; p=0.07), CLAD free survival at 3-yr was similar (48.8% vs 55.3%). Development of swallow dysfunction is common after LT surgery. While mild dysphagia, as reflected by the finding of laryngeal penetration, is the most common abnormality, a significant proportion of patients demonstrate frank aspiration. None of the pre-transplant or peri-transplant variables reliably predict post-LT aspiration risk. Despite similar morbidity outcomes early on, patients with aspiration may experience worse one-year survival.