Pleural space management after lung transplant : Early and late outcomes of pleural decortication
Copyright © 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Pleural complications after lung transplant may restrict allograft expansion, requiring decortication. However, its extent, indications, risk factors, and effect on allograft function and survival are unclear.
METHODS: From January 2006 to January 2017, 1,039 patients underwent primary lung transplant and 468 had pleural complications, 77 (16%) of whom underwent 84 surgical decortications for pleural space management. Multivariable time-related analysis was performed to identify risk factors for decortication. Mixed-effect longitudinal modeling was used to assess allograft function before and after decortication.
RESULTS: Cumulative number of decortications per 100 transplants was 1.8, 7.8, and 8.8 at 1 month, 1 year, and 3 years after transplant, respectively. Indications for the 84 decortications were complex effusion in 47 (56%), fibrothorax in 17 (20%), empyema in 11 (13%), and hemothorax in 9 (11%). Thoracoscopic operations were performed in 52 (62%) and full lung re-expansion was achieved in 76 (90%). Complications occurred after 30 (36%) decortications, with 15 pulmonary complications (18%), including 2 patients requiring extracorporeal support due to worsening function. Ten reinterventions occurred via thoracentesis (2), tube thoracostomy (1), and reoperation (7). In-hospital and 30-day mortality was 5.2% (n = 4/77). Forced expiratory volume in 1 second increased from 50% to 60% within the first year after decortication, followed by a slow decline to 55% at 5 years. Postdecortication survival was 87%, 68%, and 48% at 1, 3, and 5 years, respectively.
CONCLUSIONS: Despite high risk of reoperative surgery, decortication after lung transplant allows salvage of pleural space and graft function with a reasonable morbidity profile.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:40 |
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| Enthalten in: |
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation - 40(2021), 7 vom: 05. Juli, Seite 623-630 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Rappaport, Jesse M [VerfasserIn] |
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| Links: |
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| Themen: |
Decortication |
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| Anmerkungen: |
Date Completed 31.01.2022 Date Revised 31.01.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.healun.2021.03.021 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM325453721 |
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| 100 | 1 | |a Rappaport, Jesse M |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Pleural space management after lung transplant |b Early and late outcomes of pleural decortication |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Revised 31.01.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Pleural complications after lung transplant may restrict allograft expansion, requiring decortication. However, its extent, indications, risk factors, and effect on allograft function and survival are unclear | ||
| 520 | |a METHODS: From January 2006 to January 2017, 1,039 patients underwent primary lung transplant and 468 had pleural complications, 77 (16%) of whom underwent 84 surgical decortications for pleural space management. Multivariable time-related analysis was performed to identify risk factors for decortication. Mixed-effect longitudinal modeling was used to assess allograft function before and after decortication | ||
| 520 | |a RESULTS: Cumulative number of decortications per 100 transplants was 1.8, 7.8, and 8.8 at 1 month, 1 year, and 3 years after transplant, respectively. Indications for the 84 decortications were complex effusion in 47 (56%), fibrothorax in 17 (20%), empyema in 11 (13%), and hemothorax in 9 (11%). Thoracoscopic operations were performed in 52 (62%) and full lung re-expansion was achieved in 76 (90%). Complications occurred after 30 (36%) decortications, with 15 pulmonary complications (18%), including 2 patients requiring extracorporeal support due to worsening function. Ten reinterventions occurred via thoracentesis (2), tube thoracostomy (1), and reoperation (7). In-hospital and 30-day mortality was 5.2% (n = 4/77). Forced expiratory volume in 1 second increased from 50% to 60% within the first year after decortication, followed by a slow decline to 55% at 5 years. Postdecortication survival was 87%, 68%, and 48% at 1, 3, and 5 years, respectively | ||
| 520 | |a CONCLUSIONS: Despite high risk of reoperative surgery, decortication after lung transplant allows salvage of pleural space and graft function with a reasonable morbidity profile | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a decortication | |
| 650 | 4 | |a lung transplantation | |
| 650 | 4 | |a pleural space | |
| 650 | 4 | |a reoperation | |
| 700 | 1 | |a Siddiqui, Hafiz U |e verfasserin |4 aut | |
| 700 | 1 | |a Tang, Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a Thuita, Lucy W |e verfasserin |4 aut | |
| 700 | 1 | |a Raja, Siva |e verfasserin |4 aut | |
| 700 | 1 | |a Bribriesco, Alejandro |e verfasserin |4 aut | |
| 700 | 1 | |a Sudarshan, Monisha |e verfasserin |4 aut | |
| 700 | 1 | |a Raymond, Daniel P |e verfasserin |4 aut | |
| 700 | 1 | |a Budev, Marie |e verfasserin |4 aut | |
| 700 | 1 | |a Lane, Charles R |e verfasserin |4 aut | |
| 700 | 1 | |a Mehta, Atul |e verfasserin |4 aut | |
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| 700 | 1 | |a Murthy, Sudish C |e verfasserin |4 aut | |
| 700 | 1 | |a Blackstone, Eugene H |e verfasserin |4 aut | |
| 700 | 1 | |a Ahmad, Usman |e verfasserin |4 aut | |
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