We reviewed our experience with adult living lobar lung transplants (LL) to assess whether size and shape mismatch of donor organ to recipient predisposes to the development of pleural space problems (PSP).
Eighty-seven LL were performed on 84 adult recipients from 1993 through 2003. Seventy-six patients had cystic fibrosis (CF). Charts were examined for PSP defined as air leak or bronchopleural fistula for >7 days, pneumothorax, loculated pleural effusions, or empyema.
The overall incidence of PSP was 32%. The most common PSP was air leak/bronchopleural fistula accounting for 29% of PSPs. The second most common PSP was pleural effusion (24%). Empyema was uncommon (10% of PSP) in our series of patients despite the large contingent of cystic fibrosis patients. In 4 patients, CT-guided drainage was used for loculated effusions following chest-tube removal. Five LL patients required surgery for persistent air-leak; three required muscle flaps, and one underwent subsequent omental transfer. Two LL patients required decortication for empyema. Most patients with PSP could be managed without further surgical intervention. Donor-recipient size mismatch was not significantly different between PSP and non-PSP patients (p=0.81).
The incidence of PSP in LL recipients is similar to that reported in the literature on cadaveric transplant recipients (Ferrer et al. J Heart Lung Transplant. 2003 Nov;22(11):1217–25). Most PSPs can be managed non-operatively, although early aggressive intervention for large air leaks and judicious chest-tube management are essential for a good outcome.
The relatively small lobe in the contaminated chest cavity of LL recipients in general, and CF patients in particular, does not predispose to development of empyema despite immunosuppression.
L.M. Backhus, None.