Korean J Transplant.  2023 Nov;37(Suppl 1):S291. 10.4285/ATW2023.F-9055.

Clinical implication of the grading system for airway complications after lung transplantation

• Kim HE
• Park BS
• Yang YH
• Kim EY
• Woo A
• Park MS
• Lee JG

• KMID: 2551920
• DOI: http://doi.org/10.4285/ATW2023.F-9055

Abstract

Background
Airway complications remain a major cause of morbidity and mortality after lung transplantation. Since there were clear consensus before, 2018 International Society of Heart and Lung Transplantation (ISHLT) had proposed the universal guidelines for description of airway complications after lung transplantation. This study is aim to analyze the feasibility and reproducibility of the grading system and its clinical implication after lung transplantation.
Methods
We performed a retrospective analysis of 188 patients who underwent lung transplantation between January 2018 and December 2021. The airway complications were diagnosed by the routine fibrotic bronchoscopy after lung transplantation. We performed postoperative 1 months, 3 months, 6 months, and 1 year follow-up procedure. Demographic features and relevant clinical data were retrospectively analyzed.
Results
There are 63.1% of patients who suffered any type of airway complications after lung transplantation. percent of patients suffered any type of airway complications after lung transplantation. Ischemic or necrotic change of airway was more frequent in right side and the extent was wider in right side (18.3% vs. 30.2%; the ratio of more than grade 2 extent, 2.4% vs. 6.3%). The airway dehiscence was found only in seven patients during the study period, and all of them were more than grade 3 dehiscence, thus they underwent the surgical repair for the airway dehiscence. For the stenosis, the frequency was higher in the left side (5.6% vs. 0.8%); however, the grade and extent of the stenosis demonstrated more higher in the right side. The clinical course of the patients with airway complications were not significantly poorer; however, they showed longer hospital stays and more frequent postoperative readmission.
Conclusions
The 2018 ISHLT grading system for airway complications is feasible and shows the relevant clinical implications for grading airway complications after lung transplantation. However, it needs further investigations to modify and apply in the real world.