Incidence and risk factors of anastomotic complications after lung transplantation.

Background: Anastomotic complications are common after lung transplantation (1.4-33% of cases) and still associated with a high morbi-mortality.

Methods: The current study is a monocenter retrospective analysis of symptomatic anastomotic complications (SAC) occurring after lung transplantation between 2010 and 2016, using the macroscopic, diameter, and suture (M-D-S) classification from consensus of French experts in bronchoscopy. The objectives were to determine incidence from surgery, risk factors, and impact of survival of SAC. We defined SAC as M-D-S abnormalities (stenosis ⩾ 50% or dehiscence) requiring bronchoscopic or surgical interventions.

Results: A total of 121 patients were included. SAC occurred in 26.5% of patients ( = 32), divided in symptomatic stenosis for 23.7% ( = 29), and symptomatic dehiscence in 2.5% ( = 3). In multivariate analysis, donor bacterial lung infection [HR 2.08 (1.04-4.17),  = 0.04] and age above 50 years [HR 3.26 (1.04-10.26),  = 0.04] were associated with SAC occurrence. Cystic fibrosis etiology was associated with better survival on Kaplan-Meier curve ( < 0.001). SAC [HR 2.15 (1.07-4.32),  = 0.03] was independently associated with worst survival. The 29 symptomatic patients because of stenosis required endoscopic procedure, of whom 16 patients needed bronchial stent placement. Four patients underwent surgery: three patients because of dehiscence and one because of severe bilateral stenosis (re-transplantation).

Discussion: SAC occurred in 26.5% of patients. Donor lung infection was the only alterable identified factors. The increase rate of SAC in older patients above 50 years of age encourages in regular endoscopic monitoring.