Artikel
Aspergillus infection is a significant risk factor for anastomotic stenosis after lung transplantation
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Autoren
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J. Fertmann
- Department of Thoracic Surgery, University Hospital Munich-Grosshadern, Munich
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C. Gschwendner
- Department of Thoracic Surgery, University Hospital Munich-Grossh, Munich
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F. Spelsberg
- Department of Thoracic Surgery, University Hospital Munich-Grossh, Munich
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R. Hatz
- Department of Thoracic Surgery, University Hospital Munich-Grossh, Munich
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H. Winter
- Department of Thoracic Surgery, University Hospital Munich-Grossh, Munich
| Veröffentlicht: | 14. Oktober 2013 |
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Gliederung
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Objective: Despite advances in surgical techniques and introduction of modern immunosuppressive drugs, stenosis of the bronchial anastomosis remains a frequent and severe complication after single- and double lung transplantation implying considerable morbidity. Aim of this retrospective single-center study was identify possible risk factors for development of bronchial anastomotic stenosis.
Methods: All patients undergoing single (sLTX) and double lung transplantation (dLTX) in our center between 01/2001 and 03/2011 have been retrospectively analyzed. Data sources were the prospectively maintained LTX database, documentation systems of surgical and pulmonological endoscopy and patient records. Donor and recipient demographic data, immunological parameters, perioperative management/ postoperative course as well as donor/recipient microbiological status were examined as potential risk factors for anastomotic stenosis. Multivariate analysis was performed using logit models.
Results: A total of 319 patients (n=207 dLTX, n=112 sLTX) has been analyzed, mean follow-up was 60.3 +/– 13.1 months. N=53 recipients developed anastomotic stenosis (16.61%).
Immunologic parameters (HLA match, re-transplantation, rejection episodes) and parameters of perioperative management and postoperative course (e.g. cold ischemia time, use of HLM/ECMO, duration of postoperative ventilation) did not show any significance in the multivariate analysis. However, an association of young recipient age and cystic fibrosis as Tx indication with occurrence of anastomotic stenosis was found (p<0.05).
Whereas CMV or Pseudomonas infection was not relevant for development of stenosis, aspergillus colonization of the recipient was a highly significant risk factor (p<0.001) and could be observed more often in young CF lung transplant recipients.
Conclusion: Confirmed aspergillus colonization at the time of/after transplantation is a highly significant independent risk factor for development of anastomotic stenosis. Therefore, a strict antifungal prophylaxis and screening of colonized recipients for proper anastomotic healing seems recommendable.
