Preoperative risk factors of airway complications in adult lung transplant recipients: A systematic review and meta-analysis

Abstract

Background: In this systematic review and meta-analysis, we aimed to identify recipient-related preoperative risk factors for airway complications following lung transplantation in adults. Methods: Articles published between November 1995 and February 2023 were searched by a thorough exploration of databases. Studies that addressed recipient-related risk factors for airway complications following adult lung transplantation, such as cohorts, case-control, or cross-sectional studies, were included. Fixed-effects or random-effects models were used to calculate the odds ratios (ORs) or mean differences (MDs) with 95% confidence interval (CI). Results: Twenty-one studies including a total of 38,321 recipients fulfilled the inclusion criteria. Based on the pooled analyses, taller height (MD=5.98, 95% CI: 5.69-6.27, I2=57.32%), intraoperative mechanical ventilation (OR=1.83, 95% CI: 1.41-2.38, I2=0%), male sex (OR=1.52, 95% CI: 1.33-1.74, I2 =15.91%), preoperative extracorporeal membrane oxygenation (OR=1.58, 95% CI: 1.1-2.26, I2=41.47%), and preoperative steroid use (OR=1.21, 95% CI: 1.04-1.41, I2=0%) elevated the risk of airway complications following lung transplantation. Conclusion: Taller height, intraoperative mechanical ventilation, male sex, preoperative extracorporeal membrane oxygenation, and preoperative steroid use can increase the risk of airway complications after lung transplantation. Identifying high-risk recipients or riskless situations can support the advancement of selective treatments or prevent the unnecessary avoidance of certain interventions.