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Decortication after lung transplantation.

Daniel J Boffa1, David P Mason, Jang W Su

  • 1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.

The Annals of Thoracic Surgery
|February 23, 2008
PubMed
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Decortication after lung transplantation can help with pleural space issues, but carries significant operative risks. This procedure may improve lung function in some patients despite a substantial mortality rate.

Area of Science:

  • Thoracic surgery
  • Pulmonary medicine
  • Transplantation immunology

Background:

  • Pleural space complications like empyema and fibrothorax can compromise pulmonary allografts after lung transplantation.
  • The efficacy and safety of surgical intervention, specifically decortication, for these conditions remain largely uncharacterized.

Purpose of the Study:

  • To investigate the indications, outcomes, and survival rates associated with decortication following lung transplantation.
  • To evaluate the effectiveness of decortication in resolving pleural space pathology and improving allograft function.

Main Methods:

  • Retrospective analysis of 24 patients who underwent 27 decortications after lung transplantation between February 1990 and December 2006.
  • Data collected included indications for surgery, timing, procedural success, infection clearance, and patient survival.

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Main Results:

  • Indications included empyema (15), loculated effusion (7), hemothorax (3), and fibrothorax (2), with surgery performed at a median of 81 days post-transplant.
  • Complete lung reexpansion occurred in 70% of cases, and infection was cleared in 64% of empyema patients.
  • 1-year survival post-decortication was 60%, with a 23% operative mortality and a median length of stay of 19 days.

Conclusions:

  • Decortication can be a viable option to manage restrictive or infectious pleural space disease compromising lung allografts.
  • The procedure is associated with substantial operative risks, including significant mortality and morbidity.