Endoscopic Indicators for Obstructive Airway Complications After Lung Transplantation
| Autor: | Thomas Fuehner, Olaf Wiesner, Martin Dierich, Andre R. Simon, Tobias Welte, Gregor Warnecke, Jens Gottlieb, Christoph Duesberg |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Heart-Lung Transplantation medicine.medical_treatment Kaplan-Meier Estimate Respiratory Mucosa Single Center Risk Assessment Disease-Free Survival Bronchoscopies Necrosis Bronchoscopy Predictive Value of Tests Risk Factors Germany Surgical Wound Dehiscence medicine Humans Lung transplantation Prospective Studies Proportional Hazards Models Observer Variation Wound Healing Transplantation Chi-Square Distribution medicine.diagnostic_test business.industry Reproducibility of Results Middle Aged Surgery Airway Obstruction Treatment Outcome Predictive value of tests Female business Airway Complication Lung Transplantation |
| Zdroj: | Transplantation. 90:1210-1214 |
| ISSN: | 0041-1337 |
| Popis: | Background Obstructive airway complications (OACs) are a significant cause of morbidity after lung transplantation (LTx). Endoscopic evaluation early after LTx may help earlier identification of patients at risk. Methods Anastomotic healing process was prospectively evaluated in 169 LTx recipients by bronchoscopy between 2007 and 2009 in a single center. Bronchoscopies were performed on day 7, 14, 21, 90, 180, and 360 after LTx. A scoring system of airway healing was constructed. Results In 42 of 169 patients (25%), OAC occurred. Dehiscence (P≤0.001), extensive necrosis (P=0.001), fibrinous plug (P≤0.001), and mucosal healing at segmental level (P=0.001) on day 21 after LTx were significantly associated with later occurrence of OAC. The hereby developed Mucosal Airway Score for Healing (0-8 points, cutoff >3 points) proved to predict later OAC in 67 patients of validation phase (sensitivity=0.97; specificity=0.93; positive predictive value=0.85; and negative predictive value=0.96). Substantial interobserver agreement using Mucosal Airway Score for Healing was achieved (κ=0.617). All airway complications were managed with endoscopic intervention, and no surgical treatment was necessary. Conclusion Endoscopic appearance on day 21 after LTx predicts later occurrence of OAC. The resulting scoring system may be used in the early postoperative period as a tool to assess preventive strategies. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|