Risk factors and prognosis of airway complications after lung transplantation : A meta-analysis of 39 observational studies
J. Huanga (Dr), Z. Zhenga (Dr), J. Lina (Dr), Q. Liana (Dr), S. Huanga (Dr), Y. Liua (Dr), C. Jua (Prof), S. Li*a (Prof)
a Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, CHINA
Background: Airway complications (AC) are leading causes of significant morbidity and mortality after lung transplantation, but its predictors and outcomes remain controversial. This study aimed to identify potential risk factors and prognosis of AC after lung transplantation.
Methods: A systematic review was performed by searching PubMed, Embase and Cochrane Library. All observational studies reporting outcome and potential factors of AC after lung transplantation were included. The incidence, mortality and estimated effect of each factors for AC were pooled by using random-effects model.
Results: Thirty-nine eligible studies with 52401 patients undergoing lung transplantation were included for meta-analysis. The pooled incidence of AC was 12.4% (95% confidence interval [CI]: 9.4-15.7) and the most frequent AC is bronchial stenosis (78.3%, 1405/1853). AC-related mortality rates at 30-days, 90-days, 6 months, 1 year and 5 year were 7%, 8.5%, 20.7%, 23.5% and 44.1%, respectively. We also found that AC were associated with worse overall survival in lung transplant recipients (hazard ratio [HR] 1.66, 95%Cl 1.05-2.62). Significant predictors of increased risk of AC after lung transplantation included male recipient (odds ratio [OR] 1.59), bilateral lung transplantation (OR 2.08), mechanical ventilation (OR 1.46), cytomegalovirus infection (OR 1.16), acute rejection (OR 1.36), post-operative ICU admission (OR 1.62) and smoking history of donor (OR 1.19). Moreover, diagnosis of cystic fibrosis (OR 0.625, compared to emphysema) and perioperative usage of extracorporeal membrane oxygenation (OR 0.63) were protective factors for AC in lung transplant.
Discussion: Our study indicated that AC after lung transplantation remain common and significantly increased short- and long-term mortality. Several risk factors for AC and have been identified, providing comprehensive evidence for appropriate donor-recipient selection and optimal risk mitigation strategies.
Disclosure of funding source(s): none