Transplant infectious disease : an official journal of the Transplantation Society · 2026
Characteristics and Clinical Outcomes of Postoperative Pleural Space Infections Among Lung Transplant Recipients.
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Arzate Miranda, Nailor Michael D, Tokman Sofya, Bay Curt, Madrid Katelyn, Goodlet Kellie J
Аннотация
BACKGROUND: Pleural space infections (PSI) are a common complication after lung transplantation (LT) and have historically been linked to impaired allograft function and decreased survival, though contemporary outcome data are limited.
METHODS: This retrospective cohort included adult LT recipients (LTRs) who underwent pleural effusion drainage ≤ 90 days posttransplant from June 2013 to December 2023. Pulmonary function tests (PFTs; FEV1 and FVC percent predicted) and 1-year survival were compared between LTRs with and without culture-proven PSI using linear mixed-effects models. Survival was analyzed using an adjusted Cox proportional hazards model controlling for restrictive lung disease, with Kaplan-Meier curves to visualize survival trajectories. PSI diagnosis, microbiology, and management considerations were also described.
RESULTS: Among 1005 LTRs, 7% developed PSI (n = 72) and 30% had sterile effusions (n = 304). A pleural neutrophil percentage > 21% predicted infection with 71% sensitivity and 76% specificity. Gram-positive bacteria and Candida comprised 80% of isolates. Median antimicrobial treatment was 4 weeks, combined with pleural drainage. Surgical intervention within 30 days of nonoperative drainage was more frequent in PSI patients (22% vs. 7%, p < 0.001; two-thirds VATS procedures). PSI was associated with modest early pulmonary impairment (∼4%-7% lower PFTs), primarily reflecting stable (non-improving) values from Months 1 to Month 2. However, both groups showed similar trajectories thereafter, with >10% absolute PFT improvement from Month 1 to Month 12. One-year survival was 93% (PSI) versus 94% (non-PSI) (HR: 1.23, 95% CI: 0.44-4.43, p = 0.69).
CONCLUSION: PSI remains frequent post-LT but with contemporary management-including drainage, antimicrobials, and early surgical intervention-may no longer carry excess risk for sustained allograft dysfunction or death relative to pleural effusions without associated infection.
METHODS: This retrospective cohort included adult LT recipients (LTRs) who underwent pleural effusion drainage ≤ 90 days posttransplant from June 2013 to December 2023. Pulmonary function tests (PFTs; FEV1 and FVC percent predicted) and 1-year survival were compared between LTRs with and without culture-proven PSI using linear mixed-effects models. Survival was analyzed using an adjusted Cox proportional hazards model controlling for restrictive lung disease, with Kaplan-Meier curves to visualize survival trajectories. PSI diagnosis, microbiology, and management considerations were also described.
RESULTS: Among 1005 LTRs, 7% developed PSI (n = 72) and 30% had sterile effusions (n = 304). A pleural neutrophil percentage > 21% predicted infection with 71% sensitivity and 76% specificity. Gram-positive bacteria and Candida comprised 80% of isolates. Median antimicrobial treatment was 4 weeks, combined with pleural drainage. Surgical intervention within 30 days of nonoperative drainage was more frequent in PSI patients (22% vs. 7%, p < 0.001; two-thirds VATS procedures). PSI was associated with modest early pulmonary impairment (∼4%-7% lower PFTs), primarily reflecting stable (non-improving) values from Months 1 to Month 2. However, both groups showed similar trajectories thereafter, with >10% absolute PFT improvement from Month 1 to Month 12. One-year survival was 93% (PSI) versus 94% (non-PSI) (HR: 1.23, 95% CI: 0.44-4.43, p = 0.69).
CONCLUSION: PSI remains frequent post-LT but with contemporary management-including drainage, antimicrobials, and early surgical intervention-may no longer carry excess risk for sustained allograft dysfunction or death relative to pleural effusions without associated infection.