Endoscopic indicators for obstructive airway complications after lung transplantation.

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.