Abstract
BACKGROUND: Bronchial stenosis is a known complication after lung transplantation, but risk factors remain incompletely understood. We identified predictors of bronchial stenosis requiring bronchoscopic intervention, with a focus on post-transplant bacterial infections, and its impact on clinical outcomes. METHODS: We conducted a retrospective cohort study of 342 adult lung transplant recipients at a single center between 2017 and 2023. Bronchial stenosis was defined as localized airway narrowing requiring intervention. Clinical, perioperative, and infectious variables-censored to precede the onset of stenosis-were analyzed using univariate and multivariable logistic regression. Outcomes included survival, acute cellular and antibody-mediated rejection, and chronic lung allograft dysfunction (CLAD). RESULTS: Thirty-four patients (9.9%) developed bronchial stenosis requiring intervention. Multivariable analysis identified male sex (OR: 2.77, 95% CI: 1.13-6.79, p = 0.0261), pulmonary graft dysfunction (PGD) (OR: 3.45, 95% CI: 1.23-9.69, p = 0.0190), length of index hospitalization (OR: 1.01, 95% CI: 1.00-1.02, p = 0.0479), and any positive post-transplant bacterial respiratory culture-prior to onset of stenosis-(OR: 3.97, 95% CI: 1.67-9.48, p = 0.0019) as independent risk factors. Pneumonia and colonization with Pseudomonas aeruginosa or other gram-negatives were strongly associated with stenosis, while Staphylococcus aureus infections and colonization were not. Bronchial stenosis did not significantly impact survival, rejection, or CLAD incidence. CONCLUSIONS: Bronchial stenosis following lung transplantation is associated with PGD and bacterial airway infections, particularly Pseudomonas species or other gram negatives. These findings support an association between early gram-negative bacterial airway infections and bronchial stenosis and highlight the need for infection prevention and further prospective studies to clarify causal mechanisms and guide targeted interventions.