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Impact of Anastomotic Airway Complications following Lung Transplantation
S. C. Murthy, G. V. Gonzalez-Stawinski, T. R. Gildea, A. Mehta, M. Budev, J. M. Alster, B. Pettersson, D. P. Mason, E. H. Blackstone. The Cleveland Clinic Foundation, Cleveland, OH,
BACKGROUND: To determine prevalence and risks factors for anastomotic airway complications (AAC) following lung transplantation and examine their impact on survival.
METHODS: From 1/1992 to 1/2004, 268 patients underwent pulmonary transplantation (163 single and 104 double lung). On follow-up, 50 patients (19%) developed 58 AAC (14%) from the 371 airway anastomoses. From review of medical records and the transplant database, data were abstracted and used to determine risks for AAC and clinical impact.
RESULTS: AAC were categorized as stenosis/obstruction (36/371), dehiscence (12/371), partial necrosis (8/371), and other (2/371). Only 31 of 58 AAC required intervention; the rest resolved with expectant management. Freedom from AAC was 84% at 1 year and 76% at 5 years. Risk factors included prolonged mechanical ventilation (P=.002) and telescoping technique with running suture (P<.0001), which was performed earlier in the series. Patients ultimately developing AAC had more complicated early postoperative courses with lengthy ICU (7 vs 4 days, P=.007) and hospital stays (22 vs 14 days, P<.0001). Surprisingly, overall survival was similar for patients with and without AAC (Figure).
CONCLUSIONS: 1 in 8 airway anastomoses will be complicated by improper healing. Despite this, with appropriate management, important morbidity and mortality associated with AAC can be avoided, and patients with AAC can be restored to their expected survival curve. 
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