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Pleural space problems after living lobar transplantation
Leah M Backhus1, Eric M Sievers, Felicia A Schenkel
1Department of Cardiothoracic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California 90003, USA.
Summary
Living lobar lung transplant (LL) recipients experienced a 35% incidence of pleural space problems (PSP). Size and shape mismatch did not significantly increase PSP risk in these lung transplant patients.
Area of Science:
- Thoracic surgery
- Transplant surgery
- Pulmonary medicine
Background:
- Adult living lobar lung transplant (LL) is a complex procedure.
- Pleural space problems (PSP) are potential complications following lung transplantation.
- Understanding risk factors for PSP is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the incidence of PSP in adult living lobar lung transplant recipients.
- To determine if donor-recipient size and shape mismatch predisposes to PSP.
- To analyze the types and management of PSP in LL recipients.
Main Methods:
- Retrospective review of 87 LL procedures in 84 adult recipients (1993-2003).
- Analysis of patient records for PSP, including air leak, bronchopleural fistula, pneumothorax, effusions, and empyema.
- Comparison of donor-recipient height mismatch between patients with and without PSP.
Main Results:
- Overall incidence of PSP was 35% (24/68 patients with complete data).
- Air leak/bronchopleural fistula was the most common PSP (38%), followed by loculated pleural effusion (21%).
- Donor-recipient height mismatch was not a significant risk factor for PSP (p=0.53).
Conclusions:
- The incidence of PSP in LL recipients is comparable to cadaveric lung transplants.
- Cystic fibrosis recipients with LL do not have a significantly higher risk of empyema.
- Many PSP can be managed non-operatively, emphasizing early intervention for air leaks and careful chest tube management.