Significance of and risk factors for the development of central airway stenosis after lung transplantation
Central airways stenosis (CAS) after lung transplant is a poorly understood complication. Objectives of this study were to determine if CAS was associated with chronic rejection or worse survival after transplant as well as to identify factors associated with CAS in a large cohort of lung transplant recipients. Lung transplant recipients transplanted at a single center were retrospectively reviewed for the development of CAS requiring airway dilation. A total of 467 subjects met inclusion criteria with 60 (13%) of these developing CAS requiring intervention. Of these 60 recipients, 22 (37%) had resolution of CAS with bronchoplasty alone, while 32 (53%) ultimately required stent placement. CAS that required intervention was not a risk factor for the development of bronchiolitis obliterans syndrome or worse overall survival. Significant risk factors for the subsequent development of CAS in a time-dependant multivariable model were pulmonary fungal infections and the need for postoperative tracheostomy. While CAS was not associated with BOS or worse survival, it remains an important complication after lung transplant with potentially preventable risk factors. The authors examine a large single-center cohort of lung transplantation patients for risk factors for the development of central airway stenosis and find strong associations with fungal infections, postoperative tracheostomy, and prolonged hospitalization after transplant, but not with bronchiolitis obliterans syndrome or acute rejection. © Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons.
Shofer, SL; Wahidi, MM; Davis, WA; Palmer, SM; Hartwig, MG; Lu, Y; Snyder, LD
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