Oropharyngeal Dysphagia in Lung Transplant Patients: A Systematic Review.

Abstract

Oropharyngeal dysphagia (OPD) and laryngeal dysfunction are underrecognized yet clinically significant complications of lung transplantation. This systematic review aimed to evaluate the incidence, risk factors, and outcomes associated with posttransplant OPD and identify gaps in the existing literature. A literature search was performed using PubMed, Embase, Web of Science, and Cochrane Library databases. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Title, abstract, and full-text screening were performed by 2 reviewers with subsequent narrative synthesis. Given the heterogeneity of study design and methodology, meta-analysis was not performed. Of 1752 studies identified, 12 met inclusion criteria. Reported OPD incidence after lung transplantation ranged from 52% to 100%, with silent aspiration rates as high as 47% to 78%. Only one study included pretransplant swallowing assessments, revealing a 5-fold increase in OPD posttransplant. Risk factors were diverse, though intubation-related factors were most commonly cited. Outcome data were inconsistent, but several studies linked OPD to increased intensive care unit and total hospital length of stay, as well as higher mortality. Reported OPD incidence is higher in studies utilizing instrumental swallowing evaluation, suggesting that bedside assessment may underestimate disease burden. The current literature remains limited and heterogeneous, with minimal incorporation of both pretransplant and posttransplant assessments, underscoring the need for high-quality prospective studies to better characterize perioperative swallowing dysfunction.