title: Extended Recipient Criteria in Lung Transplantation: Impact of Pleural Abnormalities on Primary Graft Dysfunction.
abstract: BACKGROUND
  Because of improved surgical expertise and intraoperative management, pleural disease (PD+) represents a relatively minor contraindication to lung transplantation (LTx). The presence of pleural abnormalities from previous procedures or pleural involvement from fungal or bacterial disease is not considered a limiting factor for LTx. However there are no studies available to assess the impact of pleural diseases on short- and midterm outcomes after LTx.
  
  
  METHODS
  We retrospectively reviewed 163 consecutive patients who underwent LTx between 2010 and 2013. Patients were divided according to the presence of pleural abnormalities before the operation (PD+ versus PD-). The primary end point of the study was primary graft dysfunction (PGD; grade 3) and overall survival. To avoid possible selection bias and to heck the robustness of the results, a propensity score-matching analysis (1:3) was performed.
  
  
  RESULTS
  A total of 26 patients (16%) had pleural abnormalities before transplantation. Intra- and postoperative variables were comparable. PD+ was associated with a significantly higher incidence of PGD at 0 and 48 hours postoperatively (p = 0.037 and p = 0.032, respectively). Moreover, PD+ was associated with significantly worse survival at 3 months (p = 0.021). Although there was a trend toward worse early overall survival in the Kaplan-Meier estimate (Breslow p = 0.050), midterm survival was comparable (log-rank p = 0.240).
  
  
  CONCLUSIONS
  LTx in patients with preoperative pleural abnormalities is feasible. Identifying higher-risk recipients with pleural abnormalities might have important clinical relevance because of a higher incidence of PGD and worse early survival, even though midterm survival is comparable.
authors.affiliation: Department of Lung Failure and Transplant Medicine, Royal Brompton and Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex, United Kingdom.
authors.forename: Simona
authors.initials: S
authors.lastname: Soresi
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex, United Kingdom; Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany. Electronic address: zeriouh@web.de.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zeriouh
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex, United Kingdom; Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Anton
authors.initials: A
authors.lastname: Sabashnikov
authors.affiliation: Department of Lung Failure and Transplant Medicine, Royal Brompton and Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex, United Kingdom.
authors.forename: Zubair
authors.initials: Z
authors.lastname: Sarang
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex, United Kingdom.
authors.forename: Prashant N
authors.initials: PN
authors.lastname: Mohite
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex, United Kingdom.
authors.forename: Nikhil P
authors.initials: NP
authors.lastname: Patil
authors.affiliation: Department of Anaesthesiology, University Goettingen, Goettingen, Germany.
authors.forename: Ashham
authors.initials: A
authors.lastname: Mansur
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex, United Kingdom.
authors.forename: Alexander
authors.initials: A
authors.lastname: Weymann
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Wippermann
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
authors.affiliation: Department of Lung Failure and Transplant Medicine, Royal Brompton and Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex, United Kingdom.
authors.forename: Anna
authors.initials: A
authors.lastname: Reed
authors.affiliation: Department of Lung Failure and Transplant Medicine, Royal Brompton and Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Carby
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex, United Kingdom.
authors.forename: André R
authors.initials: AR
authors.lastname: Simon
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Middlesex, United Kingdom.
authors.forename: Aron-Frederik
authors.initials: AF
authors.lastname: Popov
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis; D001989:Bronchiolitis Obliterans / Q000453:epidemiology / Q000209:etiology; D000075202:Contraindications; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010995:Pleural Diseases / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D055031:Primary Graft Dysfunction / Q000453:epidemiology / Q000209:etiology*; D057216:Propensity Score; D012120:Respiration Disorders / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects; D009927:Tissue and Organ Procurement