Oropharyngeal Dysphagia Following Lung Transplantation: Incidence, Risk Factors, and Outcomes.

Abstract

Oropharyngeal dysphagia (OPD) is a risk factor for postoperative morbidity and mortality in lung transplant patients. This study evaluates the incidence and predictors of OPD following lung transplantation. A total of 394 patients who underwent lung transplantation at an academic center between February 2020 and June 2024 were retrospectively reviewed. Clinicodemographic and swallowing data were collected. Univariable and multivariable regression were used in the analysis. Postoperatively, 392 patients (99.4%) underwent Fiberoptic Endoscopic Evaluation of Swallowing (96.7%) or Modified Barium Swallow Study (3.3%). Of these, 222 (56.6%) demonstrated unsafe swallowing, as defined by penetration without clearance alone (n = 110), aspiration alone (n = 14), or both (n = 98). Aspiration was silent and undiagnosed on clinical swallowing exam in 54.5%. Aspiration pneumonia occurred in 7.2% of patients with OPD compared to 1.8% in the non-OPD group (p = 0.013). Among discharged patients, 24.7% required a modified diet. Significant predictors of posttransplant OPD in univariable analysis included male sex (odds ratio [OR] = 1.55), intubation duration (OR = 1.19), number of intubations (OR = 1.60), need for extracorporeal membrane oxygenation (OR = 2.12), tracheostomy (OR = 2.45), duration of NPO status (OR = 1.04), and abnormal vocal fold (VF) mobility (OR = 2.48). Male sex (OR = 2.34), length of intubation (OR = 1.14), and abnormal VF mobility (OR = 2.64) remained independent predictors on multivariable analysis. The high incidence of OPD and OPD with silent aspiration after lung transplantation emphasizes the need for pre- and postoperative instrumental swallowing evaluation. Future research should aim to characterize the swallowing impairment in this population and its impact on patient morbidity, lung function, and transplant success.