PDF(Pubmed)
Abstract：
Airway complications following lung transplantation remain an important cause of morbidity and mortality. We aimed to identify the incidence, risk factors and outcomes associated with clinically significant airway ischemia (CSAI) in our center. We reviewed 217 lung transplants (386 airway anastomoses) performed at our institution between February 2016 and December 2020. Airway images were graded using the 2018 ISHLT grading guidelines modified slightly for retrospective analysis. Airways were considered to have CSAI if they developed ischemia severity >B2, stenosis >50%, and/or any degree of dehiscence within 6-months of transplant. Regression analyses were used to evaluate outcomes and risk factors for CSAI. Eighty-two patients (37.8%) met criteria for CSAI. Of these, twenty-six (32%) developed stenosis and/or dehiscence, and 17 (21%) required interventions. Patients with CSAI had lower one-year (80.5% vs. 91.9%, p = 0.05) and three-year (67.1% vs. 77.8%, p = 0.08) survival than patients without CSAI. Factors associated with CSAI included younger recipient age, recipient diabetes, single running suture technique, performance of the left anastomosis first, lower venous oxygen saturation within 48-h, and takeback for major bleeding. Our single-center analysis suggests that airway ischemia remains a major obstacle in contemporary lung transplantation. Improving the local healing milieu of the airway anastomosis could potentially mitigate this risk.
摘要：
肺移植后的气道并发症仍然是发病率和死亡率的重要原因。我们的目的是确定发病率，本中心与有临床意义的气道缺血(CSAI)相关的危险因素和结局.我们回顾了2016年2月至2020年12月在我们机构进行的217例肺移植（386例气道吻合）。使用2018年ISHLT分级指南对气道图像进行分级，稍作修改以进行回顾性分析。如果发生缺血严重程度>B2，狭窄>50%，则认为气道有CSAI，和/或移植后6个月内的任何程度的开裂。回归分析用于评估CSAI的结果和危险因素。82例患者（37.8%）符合CSAI标准。其中,26例（32%）出现狭窄和/或裂开，17人(21%)需要干预。CSAI患者一年较低（80.5%vs.91.9%,p=0.05）和三年期（67.1%与77.8%,p=0.08)生存率高于无CSAI患者。与CSAI相关的因素包括较年轻的接受者年龄，受体糖尿病，单跑缝合技术，左吻合术的表现首先，在48小时内降低静脉血氧饱和度，和大出血的回收。我们的单中心分析表明，气道缺血仍然是当代肺移植的主要障碍。改善气道吻合的局部愈合环境可能会减轻这种风险。
