Abstract
Pleural space complications are common after lung transplantation. We compared outcomes between patients who underwent post-transplant pleural space surgery and those who did not.
Records of 840 patients undergoing primary bilateral lung transplantation at a single institution from 9/15/2014 to 2/25/2024 were retrospectively reviewed. Patients who underwent pleural space surgery at any time post-LTx underwent 1:2 propensity matching with those who underwent non-surgical intervention only.
791 patients met inclusion criteria; of these, 465 (58.8%) had a post-transplant intervention (surgical or non-surgical) for pleural space complications. Median survival was worse in those with intervention (intervention: 4.99 vs. no intervention: 5.70 years, p=0.010). 96 patients underwent post-transplant pleural space surgery and were matched to 192 patients with non-surgical intervention only. The most common surgical indications were pleural effusion (71%), empyema (10%), and pneumothorax (5%). Surgery was performed a median of 84 days post-transplant (IQR: 43.5–160 days). Survival was similar between surgical and non-surgical intervention groups at 1- (94.7% vs. 91.2%, p=0.255), 3- (71.1% vs. 67.1%, p=0.182), and 5-years (57.2% vs. 44.7%, p=0.981) post-transplant. Patients with surgery within 90 days post-transplant (<90 days: 6.09 vs ≥90 days: 4.93 years, p=0.327) or fewer than 3 prior non-surgical interventions (<3 interventions: 6.09 vs ≥3 interventions: 4.13 years, p=0.113) showed a trend towards longer median survival.
Surgical pleural space management after lung transplantation is associated with outcomes comparable to those of non-surgical management.
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