Thoracic Air Leak Syndrome After Hematopoietic Stem Cell Transplant in Pediatric, Adolescent, and Young Adult Population: A Surgical Dilemma.

BACKGROUND

Thoracic air leak syndrome (TALS) is a rare but severe complication of pulmonary chronic graft-versus-host disease (pGvHD) after allogeneic hematopoietic stem cell transplantation (HSCT), associated with high mortality in adult population. Evidence regarding optimal management in pediatric, adolescent, and young adult patients is limited.

METHODS

We conducted a retrospective single-center study on patients who developed radiologically confirmed TALS after allogeneic HSCT between 2010 and 2023. Patients were divided into Group A (surgical treatment) and Group B (conservative treatment). Primary outcomes were mortality rate and overall survival (OS) after TALS diagnosis. Secondary outcomes were clinical and radiologic risk factors associated with mortality and intensive care unit (ICU) admission.

RESULTS

Fifteen patients were included. Nine patients underwent surgical treatment and six patients underwent conservative treatment. Surgical management was not associated with a statistically significant survival benefit compared to conservative treatment (mortality rate 78% in Group A vs. 100% in Group B, p value 0.4857; OS 296 days in Group A vs. 102.5 days in Group B, p value 0.2331). Preexisting chronic hypoxia emerged as the strongest predictor of mortality and ICU admission and was the only independent predictor of ICU admission on multivariate analysis (odds ratio 21.12, 95% confidence interval 2.61-278.5).

CONCLUSIONS

TALS represents a manifestation of advanced pulmonary disease rather than a surgically reversible condition. Emergency surgical procedures remain essential in cases of acute respiratory compromise, but they do not appear to improve long-term prognosis. Early identification and management of pulmonary cGvHD may be critical to preventing progression toward TALS.