Risks and Outcomes Associated with Pleural Space Infections After Lung Transplantation

Abstract

<h3>Purpose</h3> Pleural space infections (PSI) are a serious complication after lung transplantation (LT) however there is limited data on the associated risk factors and outcomes of PSI. We examined: 1) risk factors associated with PSI after LT; 2) effect of PSI on LT outcomes. <h3>Methods</h3> This is a retrospective single center cohort study of 74 consecutive LT recipients (1/2018- 6/2020). Patients were divided into infected and non-infected groups, where PSI were defined as post-LT pleural effusions with pathogen(s) isolated from pleural fluid. Data were collected and compared between two groups with two-sample t-test or Fisher-exact. Multivariable logit model was performed with estimations of odds ratio (OR) and its confidence interval [CI]. <h3>Results</h3> Among 74 LT recipients, 38 (51%) developed pleural effusions requiring drainage; of them 16 (42%) had PSI. Baseline demographics were similar in patients with and without PSI (Table). Notably, 88% of PSI group received steroids pre-LT compared to 55% in the non-infected group (p<0.05); 88% of the PSI group had an underlying diagnosis of interstitial lung disease versus 45% of the non-infected group (p<0.01). Overall post-operative complications occurred more frequently in the PSI group vs. non-infected group 77% vs. 25% (p<0.01) and airway complications in 86% vs. 44% (p<0.01). Hospital length of stay was longer in the PSI group with the median of 78 versus 31 days in the non-infected group (p<0.01). Results of logistical modeling showed high risk of PSI with presence of post-LT airway complications (OR =10.8 95% CI 1.7- 72.5) and presence of post operative complications (OR=10.6, 95% CI 1.8-63.5). There was no difference in the incidence of readmissions, acute cellular rejection or 1 year mortality between the two cohorts. <h3>Conclusion</h3> PSI remain a prevalent yet under-studied complication. Airway or post-operative complications after LT were associated with PSI. One-year outcomes were similar in LT recipients with and without PSI.