Pleural space problems after living lobar transplantation.
BACKGROUND
We reviewed our experience with adult living lobar lung transplant (LL) recipients to assess whether size and shape mismatch of the donor organ to the recipient pre-disposes to the development of pleural space problems (PSP).


METHODS
Eighty-seven LL were performed on 84 adult recipients from 1993 through 2003. Seventy-six patients had cystic fibrosis. Patient records were examined for PSP, defined as air leak or bronchopleural fistula for more than 7 days; pneumothorax, loculated pleural effusions, or empyema in 68 patients for which complete data were available.


RESULTS
There were 24 PSP identified for an overall incidence of 35%. The most common PSP was air leak/bronchopleural fistula, accounting for 38% of PSP. The second most common PSP was loculated pleural effusion (21% of PSP). Empyema was uncommon (2 patients, 3% of total patients) in our series of patients despite the large population of cystic fibrosis patients. In 4 of these patients, computed tomography-guided drainage was used for loculated effusions after chest tube removal. Three LL patients underwent surgery for persistent air leak and required muscle flap repair. One of these required subsequent omental transfer. Two LL patients required decortication for empyema. Many patients with PSP could be managed without further surgical intervention (14/24 patients). Donor-recipient height mismatch was not significantly different between PSP and non-PSP patients (p = 0.53).


CONCLUSIONS
The incidence of PSP in LL recipients is similar to that reported in the literature on cadaveric transplant recipients. The relatively small lobe in the potentially contaminated chest cavity of cystic fibrosis recipients does not significantly pre-dispose to development of empyema despite immunosuppression. Many PSP can be managed non-operatively, although early aggressive intervention for large air leaks and judicious chest tube management are essential for a good outcome.
Backhus
Leah M
LM
Department of Cardiothoracic Surgery, University of Southern California Keck School of Medicine, Los Angeles, California 90003, USA.
Sievers
Eric M
EM
Schenkel
Felicia A
FA
Barr
Mark L
ML
Cohen
Robbin G
RG
Smith
Michael A
MA
Starnes
Vaughn A
VA
Bremner
Ross M
RM
D000328:Adult; D000886:Anthropometry; D015505:Chest Tubes; D003550:Cystic Fibrosis / Q000601:surgery; D046148:Donor Selection; D005260:Female; D006801:Humans; D019520:Living Donors; D008168:Lung / Q000033:anatomy & histology*; D016040:Lung Transplantation; D008297:Male; D018579:Patient Selection; D010995:Pleural Diseases / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors