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Empyema complicating successful lung transplantation
D R Nunley1, W F Grgurich, R J Keenan
1Division of Transplantation Medicine, University of Pittsburgh, PA, USA. DDDNunley@aol.com
Objective:
To assess the prevalence and etiology of empyema complicating successful lung transplantation.
Design:
Retrospective review.
Setting:
University medical center transplant service.
Patients:
All recipients (n = 392) of single-lung, double-lung, and heart-lung transplantation between May 1984 and April 1997.
Results:
Of the 392 transplant recipients, empyema was documented in 14 patients (3.6%) at a mean time (+/- SD) of 46 days after transplantation (range, 14 to 167 days). Of these 14 recipients with empyema, 4 recipients (28.6%) died of infectious complications related to empyema. Empyema was seen secondary to Gram-positive, Gram-negative, and saprophytic organisms; however, there was no predominance of a particular organism recovered from the empyemic fluid (chi2 = 0.53; p = 0.75). The development of empyema was not related to whether the transplant was performed secondary to a septic or nonseptic lung disorder (chi2 = 1.06; p = 0.67), nor was it related to the type of transplant procedure performed (ie, single-lung, double-lung, or heart-lung allografts; chi2 = 4.39; p = 0.30).
Conclusion:
Empyema, a relatively uncommon complication of lung transplantation, is not related to the type of allograft received or to whether the recipient had a septic or a nonseptic lung disorder. If empyema does occur, the mortality associated with this infection is substantial.
Insights
Empyema is an uncommon complication after lung transplantation, affecting 3.6% of patients. This serious infection, regardless of the cause or transplant type, carries a substantial mortality risk.
Area of Science:
- Pulmonary Medicine
- Transplant Surgery
- Infectious Diseases
Background:
- Empyema is a known complication following thoracic surgery and solid organ transplantation.
- Lung transplantation, while life-saving, carries risks of infectious complications.
Purpose of the Study:
- To determine the incidence and causes of empyema in lung transplant recipients.
- To identify risk factors and outcomes associated with post-transplant empyema.
Main Methods:
- Retrospective review of 392 lung transplant recipients.
- Data collected from May 1984 to April 1997 at a university medical center.
- Analysis of empyema development, causative organisms, and patient outcomes.
Main Results:
- Empyema occurred in 14 patients (3.6%) at a mean of 46 days post-transplant.
- Mortality in empyema patients was 28.6% due to infectious complications.
- No specific organism predominated, and empyema was unrelated to transplant type or pre-existing lung condition.
Conclusions:
- Empyema is an uncommon but serious complication of lung transplantation.
- The development of empyema is not linked to allograft type or the recipient's underlying lung disease.
- Prompt recognition and management are crucial due to the high mortality associated with post-lung transplant empyema.