*Purpose: Controversy still exist regarding the best induction strategy for lung transplantation. At our institution, induction is defined based on donor recipient CMV match. While less steroids are used following alemtuzumab induction, basiliximab requires a longer taper in the immediate postoperative period. We investigated the association between the type of induction and airway dehiscence following lung transplantation.

*Methods: We retrospectively reviewed 556 consecutive LT performed at our institution (6/2013 – 6/2020). Only 2 patients received thymoglobulin induction and were excluded. Airway dehiscence was confirmed by bronchoscopy and grade by ISHLT recommendations. Categorical variables were analyzed with chi-square and continuous variables were analyzed with Mann-Whitney U tests. Multivariable logistic regression was used to identify predictors of airway dehiscence.

*Results: Mean age of our cohort was 55 years old (range 20-76). There was an even distribution of alemtuzumab and basiliximab as the induction agent (278 vs 276 cases). Airway dehiscence was bronchoscopically diagnosed in 27 patients (4.9%). Variables associated with airway dehiscence included basiliximab induction (p=0.03), open chest after surgery (p=0.01), return to OR for major procedure (p=.001), and postoperative hepatic dysfunction (p=0.003). Patients who experienced airway dehiscence required longer mechanical ventilatory support (23 vs 5 days, p<0.001) and ICU stay (3 vs 2 days, p=0.048). There was no significant difference in overall survival between patients with and without bronchial dehiscence (p = 0.17). Multivariate analysis further identified only the use of basiliximab for induction as an independent predictive factor of postoperative airway dehiscence (p=0.018).

*Conclusions: Based on our analysis, patients that received basiliximab induction for lung transplantation experienced a higher risk of postoperative airway complications when compared with patient who receive alemtuzumab induction. We believe this may be associated with a higher steroid use in this population. Additional studies are necessary to further characterize the relationship between induction agents and airway complications following transplantation.

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