Hemothorax following lung transplantation: incidence, risk factors, and effect on morbidity and mortality

Abstract

Background: Hemothorax after lung transplantation may result in increased post-operative morbidity and mortality. Risk factors for developing hemothorax and the outcomes of patients who develop hemothorax have not been well studied. Methods: A retrospective chart review was performed on all patients who underwent lung transplantation at a single center between March 2009 and July 2014. Comparison was made between patients with and without hemothorax post-transplant. Results: There were 132 lung transplantations performed during the study period. Hemothorax was a complication in 17 (12.9 %) patients, occurring an average of 9 days after transplant. No difference was found between the hemothorax and non-hemothorax groups with respect to age, preoperative anticoagulation, lung allocation score, prior thoracotomy, coagulation profile, use of cardiopulmonary bypass, ischemic time, or postoperative P/F ratio. There was a trend towards a higher incidence of hemothorax in patients with underlying sarcoidosis and re-transplantation (p = 0.13 and 0.17, respectively). Hemothorax developed early (<48 h post-operatively) in 5 patients and presented in a delayed manner (≥48 h post-operatively) in 12 patients. Delayed hemothorax occurred primarily in the setting of anticoagulation (10 out of 12 patients). The hemothorax group had decreased ventilator-free days (p = 0.006), increased ICU length of stay (p = 0.01) and increased hospital length of stay (p = 0.005). Hemothorax was also associated with reduced 90-day survival (p = 0.001), but similar 1, 3, and 5-year survival (p = 0.63, p = 0.30, and p = 0.25), respectively). Conclusion: The development of hemothorax is associated with increased morbidity and decreased short-term survival. Hemothorax may present either within the first 48 h after surgery or in a delayed fashion, most commonly in the setting of anticoagulation.

Risk factors for early bleeding complications after lung transplantation – a retrospective cohort study

“…In another study of 132 lung transplant recipients, the development of postoperative hemothorax, defined by chest‐tube output and radiographic findings, was also associated with decreased short‐term survival. Most of the cases of hemothorax in that study developed more than 5 days after surgery, after the initiation of anticoagulation .…”

Early postoperative management after lung transplantation: Results of an international survey

“…Additionally, several of the underlying lung diseases are associated with an increased incidence of VTE, including fibrotic lung disease (greatest with idiopathic pulmonary fibrosis), sarcoidosis, and cystic fibrosis . Unfortunately, LTRs also have a significant risk for bleeding . Our group recently reported an incidence of hemothorax of approximately 13%, occurring on average at 9 days post‐transplant .…”

“…Unfortunately, LTRs also have a significant risk for bleeding . Our group recently reported an incidence of hemothorax of approximately 13%, occurring on average at 9 days post‐transplant . An appropriate VTE prophylaxis strategy post‐transplant must recognize both the risk for thrombosis and bleeding.…”

Advanced Pulmonary Sarcoidosis

“…In addition, different combinations of organ transplantation based on the organ involvement in a particular sarcoidosis patient, for example, lung-liver, lungkidney, and heart-liver, can be done if needed. Sarcoidosis represents 2.5% of all indications for lung transplantation, 70 with long-term outcomes matching those obtained for other conditions (median survival of 8.5 years in those patients surviving to 1 year according to the International Society for 72,73 Despite a significantly higher risk of primary graft dysfunction compared with other lung transplantation recipients, increased short-term mortality may just be related to other confounders, including the likelihood of heartlung transplantation and being African American. 74 There was no difference in the incidence of acute and chronic rejections in the sarcoid population in the largest cohort in the literature.…”