title: Decortication after lung transplantation.
abstract: BACKGROUND
  Compromise of a pulmonary allograft by restrictive or infectious pleural-space pathology may be amenable to surgical intervention; however, the role of decortication in this patient population has not yet been substantiated. To address this issue, indications and outcomes of decortication after lung transplantation were examined at our institution.
  
  
  METHODS
  From February 1990 to December 2006, 553 patients underwent lung transplantation; postoperative decortications were performed 27 times in 24 patients (4.3%).
  
  
  RESULTS
  Indications for decortication included presumed empyema (15), loculated effusion (7), hemothorax (3), and fibrothorax (2). Decortication was performed at a median of 81 days after transplantation (range, 12 days to 7.8 years). Complete lung reexpansion was achieved after 19 of 27 decortications (70%). Infection was cleared from the pleural space in 9 of 15 empyema patients (64%). Survivals at 1, 3, 6, and 12 months after decortication were 85%, 73%, 65%, and 60%, respectively. Operative mortality (30-day or in-hospital) was 23%, and median length of stay was 19 days.
  
  
  CONCLUSIONS
  Decortication may alleviate the compromise of a transplanted lung by restrictive or infectious pleural-space disease, but operative risk is substantial.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Boffa
authors.forename: David P
authors.initials: DP
authors.lastname: Mason
authors.forename: Jang W
authors.initials: JW
authors.lastname: Su
authors.forename: Sudish C
authors.initials: SC
authors.lastname: Murthy
authors.forename: Jingyuan
authors.initials: J
authors.lastname: Feng
authors.forename: Ann M
authors.initials: AM
authors.lastname: McNeill
authors.forename: Marie M
authors.initials: MM
authors.lastname: Budev
authors.forename: Atul C
authors.initials: AC
authors.lastname: Mehta
authors.forename: Gösta B
authors.initials: GB
authors.lastname: Pettersson
mesh_terms: D006801:Humans; D008171:Lung Diseases / Q000209:etiology / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D019616:Thoracic Surgical Procedures / Q000379:methods