Pleural space complications after lung transplantation

Pleural space complications are common after lung transplantation. We compared outcomes between patients who underwent posttransplant pleural space surgery and those who did not.

Records of 840 primary bilateral lung transplant recipients at a single institution from September 15, 2014, to February 25, 2024, were retrospectively reviewed. Patients who underwent pleural space surgery at any time after lung transplantation underwent 1:2 propensity matching with those who underwent nonsurgical intervention only.

In total, 791 patients met the inclusion criteria; of these, 465 (58.8%) had a posttransplant intervention (surgical or nonsurgical) for pleural space complications. Median survival was shorter in those with intervention (intervention: 4.99 vs no intervention: 5.70 years, P = .010). The 96 patients who underwent posttransplant pleural space surgery were matched to 192 patients with nonsurgical intervention only. The most common surgical indications were pleural effusion (71%), empyema (10%), and pneumothorax (5%). Surgery was performed a median of 84 days posttransplant (interquartile range, 43.5-160 days). Survival was similar between surgical and nonsurgical intervention groups at 1 (94.7% vs 91.2%, P = .255), 3 (71.1% vs 67.1%, P = .182), and 5 years (57.2% vs 44.7%, P = .981) posttransplant. Patients with surgery within 90 days posttransplant (<90 days: 6.09 vs ≥90 days: 4.93 years, P = .327) or fewer than 3 previous nonsurgical interventions (<3 interventions: 6.09 vs ≥3 interventions: 4.13 years, P = .113) showed a trend toward longer median survival.

Patients with pleural space complications after lung transplantation requiring any intervention (surgical or non-surgical) had worse outcomes than those who did not. Outcomes were comparable between patients who underwent surgical versus non-surgical intervention.