H. Curtis (Presenting) (1), S.J. Bourke (2), P.A. Corris (3), J.H. Dark (3)
(1) Adult Cystic Fibrosis Unit, Durham, United Kingdom, (2) Adult Cystic Fibrosis Unit, Newcastle upon Tyne, United Kingdom, (3) Cardiothoracic Centre, Newcastle upon Tyne, United Kingdom
High post-operative mortality secondary to haemorrhage from pleural adhesions was reported in the early experience of lung transplantation (LT). This observation led to previous pleural procedures (PPP) becoming a relativey absolute contra-indication to transplantation in some centres. Has this lead to a more conservative approach to pneumothorax (PTX) management in patients with Cystic fibrosis (CF)? What is the effect of PPP on surgical outcome of LT?
We reviewed 3 groups of LT patients.
Group A: 17 CF patients with a previous PTX"PPP.
Group B: 17 CF patients with no history of PTX.
Group C: 17 non-CFynon-bronchiectatic patients with no history of PTX.
Main outcome measures: intra-operative blood products; pleural adhesions at operation; operation and cardio-pulmonary bypass times; postop haemorrhage; times to extubation, ITU discharge and hospital discharge and 30 day mortality.
Pneumothorax: There were 37 PTX episodes in the 17 group A patients requiring 28 chest drains. Only 2 patients received medical pleurodesis and only 2 underwent surgical intervention. Lung transplantation: Packed red cells transfused intra-operatively showed a small, but significant increase for group A (P<0.05). Pleural adhesions found at operation were significantly more in group A, with dense adhesions found only in A (P<0.05). Group C was significantly more likely to be free from adhesions, with 13 patients clear compared to 7 in B and 1 i n A(P<0.01). Other outcomes showed no significant difference. Patients with CF and previous PTX"PPP undergoing LT have more pleural adhesions and higher requirement for transfusion. This does not significantly affect surgical outcome. Patients with non-CF/non-bronchiectatic were significantly more likely to be free of adhesions at LT-suggesting that the inflammatory/infective component of CF independently contributes to the increased pleural adhesions.
PPP for PTX should not be considered a contra-indication for LT.