title: Hemothorax following lung transplantation: incidence, risk factors, and effect on morbidity and mortality.
abstract: BACKGROUND
  Hemothorax after lung transplantation may result in increased post-operative morbidity and mortality. Risk factors for developing hemothorax and the outcomes of patients who develop hemothorax have not been well studied.
  
  
  METHODS
  A retrospective chart review was performed on all patients who underwent lung transplantation at a single center between March 2009 and July 2014. Comparison was made between patients with and without hemothorax post-transplant.
  
  
  RESULTS
  There were 132 lung transplantations performed during the study period. Hemothorax was a complication in 17 (12.9 %) patients, occurring an average of 9 days after transplant. No difference was found between the hemothorax and non-hemothorax groups with respect to age, preoperative anticoagulation, lung allocation score, prior thoracotomy, coagulation profile, use of cardiopulmonary bypass, ischemic time, or postoperative P/F ratio. There was a trend towards a higher incidence of hemothorax in patients with underlying sarcoidosis and re-transplantation (p= 0.13 and 0.17, respectively). Hemothorax developed early (<48 h post-operatively) in 5 patients and presented in a delayed manner (≥48 h post-operatively) in 12 patients. Delayed hemothorax occurred primarily in the setting of anticoagulation (10 out of 12 patients). The hemothorax group had decreased ventilator-free days (p= 0.006), increased ICU length of stay (p= 0.01) and increased hospital length of stay (p= 0.005). Hemothorax was also associated with reduced 90-day survival (p= 0.001), but similar 1, 3, and 5-year survival (p= 0.63,p= 0.30, andp= 0.25), respectively).
  
  
  CONCLUSIONS
  The development of hemothorax is associated with increased morbidity and decreased short-term survival. Hemothorax may present either within the first 48 h after surgery or in a delayed fashion, most commonly in the setting of anticoagulation.
authors.affiliation: Division of Pulmonary/Critical Care, University of California-Irvine, Irvine, USA.
authors.forename: Aria
authors.initials: A
authors.lastname: Hong
authors.affiliation: Advanced Lung Disease and Transplant Clinic, Inova Fairfax Hospital, Falls Church, VA USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: King
authors.affiliation: Advanced Lung Disease and Transplant Clinic, Inova Fairfax Hospital, Falls Church, VA USA.
authors.forename: A Whitney Walter
authors.initials: AW
authors.lastname: Brown
authors.affiliation: Advanced Lung Disease and Transplant Clinic, Inova Fairfax Hospital, Falls Church, VA USA.
authors.forename: Shahzad
authors.initials: S
authors.lastname: Ahmad
authors.affiliation: Advanced Lung Disease and Transplant Clinic, Inova Fairfax Hospital, Falls Church, VA USA.
authors.forename: Oksana A
authors.initials: OA
authors.lastname: Shlobin
authors.affiliation: Cardiothoracic Surgery, Inova Fairfax Hospital, Falls Church, VA USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Khandhar
authors.affiliation: Cardiothoracic Surgery, Inova Fairfax Hospital, Falls Church, VA USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Bogar
authors.affiliation: Cardiothoracic Surgery, Inova Fairfax Hospital, Falls Church, VA USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Rongione
authors.affiliation: Advanced Lung Disease and Transplant Clinic, Inova Fairfax Hospital, Falls Church, VA USA.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Nathan
keywords: Hemothorax; Interstitial lung disease; Lung transplantation