Delayed Chest Closure Following Bilateral Lung Transplantation: Risk Factors and Outcomes

Abstract

<h3>Purpose</h3> The risk factors and outcomes of delayed chest closure (DCC) following bilateral lung transplantation (BLTx) remain largely unknown. This study aimed to close this gap by identifying risk factors for DCC and comparing the outcomes to patients with primary chest closure (PCC) following BLTx. <h3>Methods</h3> This retrospective single-center study included patients undergoing BLTx between 2013 - 2020. Univariable and multivariable logistic regression was utilized to identify DCC risk factors from collected demographic and perioperative clinical data. Propensity score matching was used to generate well-matched pairs (1:1) to evaluate length of stay (LOS), survival, and infection following transplant. <h3>Results</h3> 383 total BLTx were performed, with 34 (8.9%) requiring DCC. Univariable analysis identified multiple risk factors, mostly related to candidate demographics and pre-transplant acuity of illness (Table 1). While on multivariable analysis pre-transplant ECMO was the strongest single predictor for DCC, the model with the highest AUC revealed that LAS and allograft lung volume reduction were also significant factors. Survival rates were comparable at all time points (Figure 1), with no increase in surgical-site infection rates in the 1^st post-transplant year (9.4% vs. 12.5%, p=0.728). However, LOS was significantly longer for DCC patients (35 vs. 20 days, p<0.001). <h3>Conclusion</h3> DCC in critically ill BLTx recipients is a viable management option with comparable short- and long-term survival and infection rates to PCC. Risk factors for DCC in this study included pre-transplant ECMO, increasing LAS, and allograft volume reduction.