Background: Initially a previous intrapleural procedure causing a partially or completely fused pleural space represented a contraindication to lung transplantation. However, as experience with transplantation increased, particularly in patients with septic lung diseases who frequently have pleural adhesions, a previous intrapleural procedure became a relative rather than an absolute contraindication. The "clam shell" incision, which allows better control of the pleural spaces than a median sternotomy, contributed to this change.
Methods: The outcome of 18 patients with a previous intrapleural procedure was compared with 18 paired controls without previous surgery involving the transplanted pleural space.
Results: Five study patients had a predictably fused pleural space from their previous surgery, and four had extensive adhesions (major previous intrapleural procedures). The nine patients with minor previous intrapleural procedures had undergone more limited intrapleural procedures (open lung biopsy or chest tube drainage of a pneumothorax). There was no statistically significant trend for the operating time, blood loss, transfusion requirements, time intubated, and intensive care unit stay to be greater in the study population than in the controls. However, the major previous intrapleural procedure patients were younger, required longer cardiopulmonary bypass, and had a longer intensive care unit stay. The 6- and 12-month forced expiratory volumes in 1 second from the patients with major previous intrapleural procedures were not different from those of either the patients with minor previous intrapleural procedures or the controls.
Conclusions: A previous intrapleural procedure, even when resulting in a fused pleural space, did not have a significant detrimental impact on outcome. Therefore a previous intrapleural procedure should neither preclude listing a patient for transplantation nor significantly influence the choice of recipient when lungs become available for transplantation.