• Simona Soresi, Mohamed Zeriouh, Anton Sabashnikov, Zubair Sarang, Prashant N Mohite, Nikhil P Patil, Ashham Mansur, Alexander Weymann, Jens Wippermann, Thorsten Wahlers, Anna Reed, Martin Carby, André R Simon, and Aron-Frederik Popov.
• Department of Lung Failure and Transplant Medicine, Royal Brompton and Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex, United Kingdom.
• Ann. Thorac. Surg. 2016 Jun 1; 101 (6): 2112-9.

BackgroundBecause of improved surgical expertise and intraoperative management, pleural disease (PD+) represents a relatively minor contraindication to lung transplantation (LTx). The presence of pleural abnormalities from previous procedures or pleural involvement from fungal or bacterial disease is not considered a limiting factor for LTx. However there are no studies available to assess the impact of pleural diseases on short- and midterm outcomes after LTx.MethodsWe retrospectively reviewed 163 consecutive patients who underwent LTx between 2010 and 2013. Patients were divided according to the presence of pleural abnormalities before the operation (PD+ versus PD-). The primary end point of the study was primary graft dysfunction (PGD; grade 3) and overall survival. To avoid possible selection bias and to heck the robustness of the results, a propensity score-matching analysis (1:3) was performed.ResultsA total of 26 patients (16%) had pleural abnormalities before transplantation. Intra- and postoperative variables were comparable. PD+ was associated with a significantly higher incidence of PGD at 0 and 48 hours postoperatively (p = 0.037 and p = 0.032, respectively). Moreover, PD+ was associated with significantly worse survival at 3 months (p = 0.021). Although there was a trend toward worse early overall survival in the Kaplan-Meier estimate (Breslow p = 0.050), midterm survival was comparable (log-rank p = 0.240).ConclusionsLTx in patients with preoperative pleural abnormalities is feasible. Identifying higher-risk recipients with pleural abnormalities might have important clinical relevance because of a higher incidence of PGD and worse early survival, even though midterm survival is comparable.Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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