Need for tracheostomy after lung transplant predicts decreased mid- and long-term survival

Stephen J. Huddleston; Roland Brown; Kyle Rudser; Umesh Goswami; Rade Tomic; Nicholas T. Lemke; Andrew W. Shaffer; Matthew Soule; Marshall Hertz; Sara Shumway; Rose Kelly; Gabriel Loor

doi:10.1111/ctr.13766

Need for tracheostomy after lung transplant predicts decreased mid- and long-term survival

Stephen J. Huddleston, Roland Brown, Kyle Rudser, Umesh Goswami, Rade Tomic, Nicholas T. Lemke, Andrew W. Shaffer, Matthew Soule, Marshall Hertz, Sara Shumway, Rose Kelly, Gabriel Loor

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Abstract

Background: Tracheostomy is an important adjunct for lung transplant patients requiring prolonged ventilation. We explored the effects of post-transplant tracheostomy on survival and bronchiolitis obliterans syndrome after lung transplant. Methods: A retrospective, single center analysis was performed on all lung transplant recipients during the Lung Allocation Score (LAS) era. Risk factors for post-transplant tracheostomy or death within 30 days were assessed. Kaplan-Meier estimates and Cox proportional hazards models were used to examine the association between tracheostomy within 30 days after transplant and survival at 1 and 3 years. A total of 403 patients underwent single or bilateral lung transplant between May 2005 and February 2016 with complete data for 352 cases, and 35 patients (9.9%) underwent tracheostomy or died (N = 10, 2.8%) within 30 days. Results: In adjusted analyses, primary graft dysfunction grade 3 (PGD3) was associated with a composite end point of tracheostomy or death within 30 days (HR 3.11 (1.69, 5.71), P-value <.001). Tracheostomy within 30 days was associated with decreased survival at 1(HR 4.25 [1.75, 10.35] P-value =.001) and 3 years (HR 2.74 [1.30, 5.76], P-value =.008), as well as decreased bronchiolitis obliterans (BOS)-free survival at 1 (HR 1.87 [1.02, 3.41] P-value =.042) and 3 years (HR 2.15 [1.33, 3.5], P-value =.002). Conclusion: Post-transplant tracheostomy is a marker for advanced lung allograft dysfunction with significant reduction in long-term overall and BOS-free survival.

Original language	English (US)
Article number	e13766
Journal	Clinical Transplantation
Volume	34
Issue number	1
DOIs	https://doi.org/10.1111/ctr.13766
State	Published - Jan 1 2020

Bibliographical note

Funding Information:
Contributions by Drs. Brown and Rudser were supported in part by award UL1TR002494 from the National Center for Advancing Translational Sciences of the National Institutes of Health Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Jeanne Traaseth assisted in editing and preparation of the manuscript.

Funding Information:
The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation. Dr Huddleston has received grant support from TransMedics (Andover, MA) for the INSPIRE and EXPAND I and II Trials related to ex vivo lung perfusion. Dr Loor has received funding from TransMedics (Andover, MA) for the INSPIRE and EXPAND I and II Trials related to ex vivo lung perfusion.

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© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

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@article{98ba358df5dd4b4885978360f120e465,

title = "Need for tracheostomy after lung transplant predicts decreased mid- and long-term survival",

abstract = "Background: Tracheostomy is an important adjunct for lung transplant patients requiring prolonged ventilation. We explored the effects of post-transplant tracheostomy on survival and bronchiolitis obliterans syndrome after lung transplant. Methods: A retrospective, single center analysis was performed on all lung transplant recipients during the Lung Allocation Score (LAS) era. Risk factors for post-transplant tracheostomy or death within 30 days were assessed. Kaplan-Meier estimates and Cox proportional hazards models were used to examine the association between tracheostomy within 30 days after transplant and survival at 1 and 3 years. A total of 403 patients underwent single or bilateral lung transplant between May 2005 and February 2016 with complete data for 352 cases, and 35 patients (9.9%) underwent tracheostomy or died (N = 10, 2.8%) within 30 days. Results: In adjusted analyses, primary graft dysfunction grade 3 (PGD3) was associated with a composite end point of tracheostomy or death within 30 days (HR 3.11 (1.69, 5.71), P-value <.001). Tracheostomy within 30 days was associated with decreased survival at 1(HR 4.25 [1.75, 10.35] P-value =.001) and 3 years (HR 2.74 [1.30, 5.76], P-value =.008), as well as decreased bronchiolitis obliterans (BOS)-free survival at 1 (HR 1.87 [1.02, 3.41] P-value =.042) and 3 years (HR 2.15 [1.33, 3.5], P-value =.002). Conclusion: Post-transplant tracheostomy is a marker for advanced lung allograft dysfunction with significant reduction in long-term overall and BOS-free survival.",

author = "Huddleston, {Stephen J.} and Roland Brown and Kyle Rudser and Umesh Goswami and Rade Tomic and Lemke, {Nicholas T.} and Shaffer, {Andrew W.} and Matthew Soule and Marshall Hertz and Sara Shumway and Rose Kelly and Gabriel Loor",

note = "Funding Information: Contributions by Drs. Brown and Rudser were supported in part by award UL1TR002494 from the National Center for Advancing Translational Sciences of the National Institutes of Health Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Jeanne Traaseth assisted in editing and preparation of the manuscript. Funding Information: The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation. Dr Huddleston has received grant support from TransMedics (Andover, MA) for the INSPIRE and EXPAND I and II Trials related to ex vivo lung perfusion. Dr Loor has received funding from TransMedics (Andover, MA) for the INSPIRE and EXPAND I and II Trials related to ex vivo lung perfusion. Publisher Copyright: {\textcopyright} 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd",

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T1 - Need for tracheostomy after lung transplant predicts decreased mid- and long-term survival

AU - Huddleston, Stephen J.

AU - Brown, Roland

AU - Rudser, Kyle

AU - Goswami, Umesh

AU - Tomic, Rade

AU - Lemke, Nicholas T.

AU - Shaffer, Andrew W.

AU - Soule, Matthew

AU - Hertz, Marshall

AU - Shumway, Sara

AU - Kelly, Rose

AU - Loor, Gabriel

N1 - Funding Information: Contributions by Drs. Brown and Rudser were supported in part by award UL1TR002494 from the National Center for Advancing Translational Sciences of the National Institutes of Health Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Jeanne Traaseth assisted in editing and preparation of the manuscript. Funding Information: The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation. Dr Huddleston has received grant support from TransMedics (Andover, MA) for the INSPIRE and EXPAND I and II Trials related to ex vivo lung perfusion. Dr Loor has received funding from TransMedics (Andover, MA) for the INSPIRE and EXPAND I and II Trials related to ex vivo lung perfusion. Publisher Copyright: © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Background: Tracheostomy is an important adjunct for lung transplant patients requiring prolonged ventilation. We explored the effects of post-transplant tracheostomy on survival and bronchiolitis obliterans syndrome after lung transplant. Methods: A retrospective, single center analysis was performed on all lung transplant recipients during the Lung Allocation Score (LAS) era. Risk factors for post-transplant tracheostomy or death within 30 days were assessed. Kaplan-Meier estimates and Cox proportional hazards models were used to examine the association between tracheostomy within 30 days after transplant and survival at 1 and 3 years. A total of 403 patients underwent single or bilateral lung transplant between May 2005 and February 2016 with complete data for 352 cases, and 35 patients (9.9%) underwent tracheostomy or died (N = 10, 2.8%) within 30 days. Results: In adjusted analyses, primary graft dysfunction grade 3 (PGD3) was associated with a composite end point of tracheostomy or death within 30 days (HR 3.11 (1.69, 5.71), P-value <.001). Tracheostomy within 30 days was associated with decreased survival at 1(HR 4.25 [1.75, 10.35] P-value =.001) and 3 years (HR 2.74 [1.30, 5.76], P-value =.008), as well as decreased bronchiolitis obliterans (BOS)-free survival at 1 (HR 1.87 [1.02, 3.41] P-value =.042) and 3 years (HR 2.15 [1.33, 3.5], P-value =.002). Conclusion: Post-transplant tracheostomy is a marker for advanced lung allograft dysfunction with significant reduction in long-term overall and BOS-free survival.

AB - Background: Tracheostomy is an important adjunct for lung transplant patients requiring prolonged ventilation. We explored the effects of post-transplant tracheostomy on survival and bronchiolitis obliterans syndrome after lung transplant. Methods: A retrospective, single center analysis was performed on all lung transplant recipients during the Lung Allocation Score (LAS) era. Risk factors for post-transplant tracheostomy or death within 30 days were assessed. Kaplan-Meier estimates and Cox proportional hazards models were used to examine the association between tracheostomy within 30 days after transplant and survival at 1 and 3 years. A total of 403 patients underwent single or bilateral lung transplant between May 2005 and February 2016 with complete data for 352 cases, and 35 patients (9.9%) underwent tracheostomy or died (N = 10, 2.8%) within 30 days. Results: In adjusted analyses, primary graft dysfunction grade 3 (PGD3) was associated with a composite end point of tracheostomy or death within 30 days (HR 3.11 (1.69, 5.71), P-value <.001). Tracheostomy within 30 days was associated with decreased survival at 1(HR 4.25 [1.75, 10.35] P-value =.001) and 3 years (HR 2.74 [1.30, 5.76], P-value =.008), as well as decreased bronchiolitis obliterans (BOS)-free survival at 1 (HR 1.87 [1.02, 3.41] P-value =.042) and 3 years (HR 2.15 [1.33, 3.5], P-value =.002). Conclusion: Post-transplant tracheostomy is a marker for advanced lung allograft dysfunction with significant reduction in long-term overall and BOS-free survival.

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Need for tracheostomy after lung transplant predicts decreased mid- and long-term survival

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