Acute and chronic pleural complications in lung transplantation.
BACKGROUND
Lung transplant recipients may have pleural complications. However, the influence of these complications on the prognosis is not well known.


METHODS
We analyzed pleural complications and clinical and radiologic data from 100 patients who underwent lung transplantation in a general hospital in a 9-year period. Pre-operative evaluation, surgical protocol, immunosuppressive regimen, and follow-up were carried out systematically. Chest computerized tomography (CT) was performed at 3 and 12 months after transplantation.


RESULTS
All patients had early post-operative pleural effusion ipsilateral to the graft, which required drainage for a mean of 19.3 days (range, 5-52 days). Thirty-four patients had 43 acute pleural complications: 15 hemothoraxes, 10 persistent air leaks, 8 pneumothoraxes, 7 transient air leaks, and 3 empyemas. Multivariate analysis showed hemothorax and persistent air leak were associated with increased post-operative mortality (p = 0.024, p = 0.011, respectively). Post-operative mortality was not associated with any pre-transplant variable. Chest CT findings at 3 months revealed > or =1 pleural alteration in 58 of 70 patients (83%): 34 post-operative residual ipsilateral pleural effusions; 36 pleural thickenings; and 3 residual pneumothoraxes, 1 with a coexisting bronchial dehiscence. Chest CT at 12 months showed pleural alterations in 50 of 58 patients (86%): pleural thickening in 48, calcification in 4, and residual pleural effusion in 4.


CONCLUSIONS
Pleural complications are common in lung transplant recipients. Hemothorax and persistent air leak are associated with increased post-operative mortality. Chest CT showed pleural alterations in most patients 12 months after transplantation.
Servei de Pneumologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain. jjferrer@hg.vhebron.es
Jaume
J
Ferrer
Juan
J
Roldan
Antonio
A
Roman
Carlos
C
Bravo
Victor
V
Monforte
Esther
E
Pallissa
Ignasi
I
Gic
Joan
J
Sole
Ferran
F
Morell
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006491:Hemothorax / Q000209:etiology; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000401:mortality; D010996:Pleural Effusion / Q000209:etiology; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed