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Previous intrapleural procedures do not adversely affect lung transplantation
M Dusmet1, T L Winton, S Kesten
1Toronto Hospital, Ontario, Canada.
Summary
A prior intrapleural procedure, even with pleural adhesions, does not negatively impact lung transplantation outcomes. These findings suggest previous surgery should not prevent patients from being listed for lung transplants.
Area of Science:
- Cardiothoracic Surgery
- Pulmonary Medicine
- Transplant Surgery
Background:
- Previous intrapleural procedures historically contraindicated lung transplantation due to potential pleural fusion.
- Increasing experience, especially in septic lung disease patients with adhesions, shifted this to a relative contraindication.
- Advancements like the "clam shell" incision improved pleural space management.
Purpose of the Study:
- To evaluate the impact of prior intrapleural procedures on lung transplantation outcomes.
- To compare outcomes between lung transplant recipients with and without previous pleural surgery.
Main Methods:
- A retrospective comparison of 18 lung transplant patients with prior intrapleural procedures against 18 matched controls.
- Categorization of prior procedures into minor (e.g., chest tube, biopsy) and major (extensive adhesions).
Main Results:
- No significant differences in operating time, blood loss, or intubation duration between groups.
- Patients with major prior procedures were younger and had longer cardiopulmonary bypass and ICU stays.
- Forced expiratory volume in 1 second at 6 and 12 months was comparable across all groups.
Conclusions:
- Prior intrapleural procedures, including fused pleural spaces, do not significantly worsen lung transplant outcomes.
- Previous pleural surgery should not be a barrier to listing patients for lung transplantation.
- Recipient selection should not be unduly influenced by a history of intrapleural procedures.