Abstract
Delayed chest closure (DCC) is a strategy for managing complex lung transplantation (LTx) cases. We compared the short- and long-term impacts of DCC to those of primary chest closure (PCC).
We retrospectively analyzed LTx procedures between 9/15/2014 and 2/25/2024 at a single center, excluding single-lung, redo, and multi-organ cases. Propensity score matching balanced donor, recipient, and intraoperative factors. Outcomes and survival were evaluated using univariable/multivariable and Kaplan-Meier analyses, respectively.
Of 692 patients, 127 (18%) underwent DCC and 565 (82%) underwent PCC; 86 well-matched pairs were generated. Factors independently associated with DCC included increasing mean pulmonary artery pressure at registration (aOR 1.028, 95%CI 1.002–1.056, p=0.038), ECMO bridge to transplant (aOR 2.796, 95%CI 1.138–6.869, p=0.025), donation after circulatory death allograft (aOR 3.263, 95%CI 1.620–6.571, p<0.001), cardiopulmonary bypass during transplant (aOR 2.613, 95%CI 1.454–4.696, p=0.001), greater transfusion volume (aOR 1.354 per unit of pRBCs, 95%CI 1.233–1.487, p<0.001), and prolonged ischemic time (aOR 1.192 per hour, 95%CI 1.063–1.336, p=0.003). Postoperatively, DCC recipients experienced higher rates of grade 3 primary graft dysfunction at 72 hours (49% vs 23%, p=0.008), mechanical ventilation at 72 hours, ECMO use, tracheostomy, prolonged ventilatory support, dialysis, and longer hospitalizations (all p<0.05). Rates of sternal disunion, empyema, and unplanned return to operating room (all p>0.3) and overall survival (p=0.505) were comparable between groups.
Well-matched patients who underwent DCC or PCC had comparable rates of pleural space infection, sternal nonunion, and overall survival, although DCC patients had higher rates of early postoperative morbidity.