P6: Decortication after lung transplantation

Abstract

Purpose: Pleural complications are common after lung transplantation and may compromise allograft function. Lung entrapment resulting from loculated pleural effusion, empyema or fibrothorax is often amenable to surgical decortication. However, obliterated tissue planes and fragility of the transplanted lung make decortication more technically challenging and less predictable in this group. We examined our experience with decortication in lung transplant recipients to characterize pleural pathology, determine the extent of lung re-expansion, and analyze patient outcome. Methods: We identified 490 patients in our prospective database that underwent lung transplantation at the Cleveland Clinic between February, 1990 and January, 2006. Results: Decortication was performed 20 times in 19 patients (3.9%), a median of 86 days after lung transplant (range 12 to 964days). Suspected empyema was the most common indication for operation (11), followed by loculated effusion (6), hemothorax (2) and fibrothorax (1). Complete re-expansion of the transplanted lung was achieved after 16 of the 20 decortications (80%). The median length of stay was 17.5days (range 3-102) and the operative mortality was 25%. Conclusions: Empyema is the most common indication for decortication after lung transplant followed by loculated pleural effusion and hemothorax. While decortication leads to complete expansion of the majority of transplanted lungs, the length of stay is long and mortality high. Clinical implications Decortication should be used selectively after lung transplantation, weighing the risks of lung entrapment and pleural space infection against considerable operative mortality.