Pleural complications in lung transplantation
- Lorriana Leard, MD
Lorriana Leard, MD
- Associate Professor of Clinical Medicine
- University of California San Francisco
Pleural disease is an important consideration in patients undergoing lung transplantation. For some patients being considered as candidates for lung transplant, pre-existing pleural disease may increase their risk of postoperative pleural complications. Even in the absence of pre-existing pleural disease, pleural complications following lung transplantation are common due to disruption of the pleural space at the time of transplant surgery, complications related to rejection of the allograft, and the immunosuppression regimen post-transplant.
The risk factors for pleural complications and the postoperative pleural complications that develop in patients undergoing lung transplantation will be reviewed here. Issues regarding the selection of candidates for lung transplantation and the physiologic changes that occur following lung transplantation are discussed separately. (See "Lung transplantation: General guidelines for recipient selection" and "Physiologic changes following lung transplantation".)
RISK FACTORS FOR PLEURAL COMPLICATIONS
Lung transplant recipients with pre-existing pleural space abnormalities and donor-recipient size mismatch are at increased risk of pleural complications at the time of lung transplant surgery.
Pre-existing pleural space abnormalities — Pre-existing pleural disease may increase the risk of intraoperative and postoperative complications following lung transplantation, but is not necessarily considered a contraindication to lung transplantation . At the time of lung transplantation, a recipient's native lung must be completely removed from that thoracic cavity. Pleural adhesions may make it much more difficult to remove the native lung, increasing operative time and placing the patient at increased risk for intraoperative bleeding.
Pre-existing pleural space abnormalities may be secondary to many different etiologies, such as prior pneumothorax, hemothorax, chylothorax, empyema, or pleural adhesions. Underlying suppurative lung disease and prior surgical lung biopsy can lead to pleural adhesions. In addition, treatment of these pleural space diseases by the placement of chest tubes, pleurodesis, or pleurectomy may further contribute to pleural space abnormalities that may complicate lung transplantation.
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- RISK FACTORS FOR PLEURAL COMPLICATIONS
- Pre-existing pleural space abnormalities
- Donor-recipient size mismatches
- PLEURAL COMPLICATIONS FOLLOWING LUNG TRANSPLANTATION
- Pleural effusions
- - Pleural effusions early post-transplant
- - Pleural effusions late post-transplant
- Pleural fibrosis and pleuroparenchymal fibroelastosis
- INTERPLEURAL COMMUNICATION
- SUMMARY AND RECOMMENDATIONS