Survival After Lung Transplantation is Conditional to Bronchial Complications

Abstract

<h3>Purpose</h3> Bronchial complications (BC) following lung transplant have a significant impact on morbidity and mortality. The published incidence of bronchial complications varies between 2 and 18%. This study was undertaken to analyse our experience with BC following lung transplantation in first 300 patients at our unit. <h3>Methods</h3> A retrospective analysis of our first 300 lung transplant recipients from 1993 to 2019 was undertaken with regards to BC. Recipient and donor-specific risk factors were analysed. Patients were divided into two groups: Group A, with and Group B, without BC. A <i>p</i> value of < 0.05 was considered statistically significant with statistical analysis performed using SAS v9.4. Graft salvage was achieved in a small subset of patients. <h3>Results</h3> 47 patients (15.6%) developed BC. On univariate analysis, recipient risk factors predictive of bronchial complications were male sex, age, a diagnosis of cystic fibrosis and Alpha 1 antitrypsin deficiency, respiratory colonisation and prolonged post-operative ventilation. Male donors posed higher risk. However, on stepwise multivariate logistic regression analysis, only recipient male gender, recipient age, and prolonged ventilation were significant. The median follow-up was 6.2 years. The survival rates were 93.4%, 87.4%, 83.2%, and 53.8% at 30 days, 90 days, 1 year, and 5 years respectively. The median survival varied, was 3.9 years (Group A) and 6.2 years (Group B).The 30 day, 90-day, 1-year and 5-year actuarial survival rates were significantly lower for recipients with bronchial complications. Patients with BC had twice the mortality within one year. BC contributed to early mortality and similar long term survival curves for those with and without BC. <h3>Conclusion</h3> Development of major bronchial complications is one of the important factors in determining morbidity and survival following lung transplantation. However, the conditional survival following three months after surgery is similar and early intervention may prolong survival.