Surgical Site Infection in Lung Transplantation: Clinical Impact and Predictive Factors: Analysis From the Portuguese Lung Transplantation Center.

INTRODUCTION

Surgical site infection (SSI) after lung transplantation is an under-reported complication, despite its potential impact on postoperative morbidity and clinical outcomes. This study aims to evaluate the clinical impact and identify predictors of SSI in lung transplant recipients.

METHODS

A retrospective observational study was conducted including patients who underwent lung transplantation at the Portuguese Lung Transplantation Center between January 2016 and December 2024, with follow-up until June 2025. Univariate and multivariate analyses were performed to identify independent predictors.

RESULTS

Among 316 transplanted patients, 25 (7.9%) developed SSI. Deep infections represented 80% of cases, including 5 with sternal osteomyelitis, occurring at a median of 25 days post-transplant (IQR: 17-43). Gram-negative bacteria were most frequently isolated, particularly Enterobacteriaceae. Negative-pressure wound therapy was used in 17 (68%) patients, and 8 (32%) required surgical debridement. Patients with SSI were older, predominantly female and had a higher body mass index (BMI). Moreover, they presented significantly longer ICU stay, drainage duration and hospital stay (all p < .05). No significant differences were observed regarding primary graft dysfunction, acute or chronic rejection, or mortality. In multivariate analysis, female sex (OR 3.15; 95% CI: 1.33-7.48) and higher BMI (OR 1.21; 95% CI: 1.05-1.32) were risk factors for SSI.

CONCLUSION

SSI after lung transplantation is associated with significant postoperative morbidity, underscoring that this complication, although underestimated, remains clinically relevant. The incidence observed in our center (7.9%) is comparable to that reported in the literature. Early identification of high-risk patients may support the implementation of tailored strategies and optimize perioperative management.