Pleural disease in patients undergoing lung transplantation for cystic fibrosis

Cystic fibrosis (CF) is associated with varying degrees of pleural inflammatory reaction that occurs as a result of chronic pulmonary infections and intervention to pleural space. The amount of pleural reaction is associated with the difficulty involved when performing the pneumonectomy at the time of lung replacement. The aim of this study is to identify possible pre-transplantation parameters that may predict the extent of pleural adhesion density. The charts of the 32 CF patients who underwent lung transplantation were reviewed. The degree of pleural adhesions was graded as none, minimal, moderate or severe, by extensive retrospective chart review of the operative and pathology reports. Available Brasfield radiographic scores, chest computerized tomographic (CT) scan scores, and pulmonary function test results were correlated to the pleural density grades. CT scans were scored by one radiologist as none, mild focal, moderate focal, diffuse mild or severe pleural disease. The presence of severe adhesions was associated with lower diffusion capacity corrected for volume (DL(CO)/VA) (p=0.0022) and older age (p<0.05) at the time of transplant. The typical radiographic and pulmonary function findings of airway obstruction, parenchymal nodularity and air trapping did not correlate with pleural adhesion density. The eleven patients with severe pleural adhesions had a longer ICU course and remained intubated longer than the thirteen patients with none or minimal adhesions. The extent of severe adhesions associated with CF cannot be predicted by preoperative Brasfield radiographic scores of parenchymal disease or spirometry data. However, chest CT imaging and DL(CO)/VA measurements may be useful in predicting the extent of pleural adhesions and the degree of dissection difficulty associated with the pneumonectomies for lung transplantation in the CF recipients.