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RECURRENT THORACIC AIR LEAK SYNDROME IN PATIENTS AFFECTED BY PULMONARY GRAFT-VERSUS-HOST DISEASE: SURGICAL STRATEGIES AND OUTCOME
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  • Giorgio PERSANO,
  • Alessandro CROCOLI,
  • Cristina MARTUCCI,
  • Valerio Pardi,
  • Pier Luigi DI PAOLO,
  • Francesca Petreschi,
  • Giulia CAFIERO,
  • Alessandro Inserra
Giorgio PERSANO
Ospedale Pediatrico Bambino Gesu

Corresponding Author:[email protected]

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Alessandro CROCOLI
Ospedale Pediatrico Bambino Gesu
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Cristina MARTUCCI
Ospedale Pediatrico Bambino Gesu
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Valerio Pardi
Ospedale Pediatrico Bambino Gesu
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Pier Luigi DI PAOLO
Ospedale Pediatrico Bambino Gesu
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Francesca Petreschi
Ospedale Pediatrico Bambino Gesu
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Giulia CAFIERO
Ospedale Pediatrico Bambino Gesu
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Alessandro Inserra
Ospedale Pediatrico Bambino Gesu
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Abstract

Background and aims Thoracic air leak syndrome (TALS) is a complication related to chronic pulmonary graft-versus-host disease (pGvHD) that affects approximately 0.83% to 3.08% patients after allogenic hematopoietic stem cell transplant. Such complication is defined as the occurrence of any form of air leak in the thorax, including spontaneous pneumomediastinum or pneumopericardium, subcutaneous emphysema, interstitial emphysema and pneumothorax and has a negative impact on post-transplant survival. The aim of the present study is to describe a single-center experience in the surgical management of recurrent TALS in adolescents and young adults and its outcome. Methods We retrospectively reviewed the clinical notes of patients with previous allogenic hematopoietic stem cell transplant who underwent surgical procedures for recurrent TALS from January 2016 until March 2021. As well we analyzed clinical data, number of episodes of thoracic air leak, surgical procedures and relative outcome. Results In the examined period, four patients, aged 16 to 25 years, underwent surgical procedures for TALS, including thoracostomy tube placement, thoracoscopic pleurodesis and thoracotomy. All the patients had been diagnosed with pGvHD before the onset of TALS, with a mean time lapse of 276 days (range 42 – 513). These patients experienced on average 4.5 air leak episodes (range 3 – 6). All the patients experienced at least two episodes before surgery. One patient underwent emergency tube thoracostomy only, three patients underwent thoracoscopic pleurodesis and two patients underwent thoracotomy. After surgery, patients were free from air leak symptoms for a mean time of 176 days (range 25 – 477). Pulmonary function progressively deteriorated, and all the patients eventually died because of respiratory failure after a mean time of 483 days (range 127 – 1045) after the first episode of air leak. Conclusions Surgery provides temporary relief to symptoms related to TALS. When TALS develops, pulmonary function progressively worsens toward respiratory failure and death.
09 Apr 2023Submitted to Pediatric Pulmonology
09 Apr 2023Submission Checks Completed
09 Apr 2023Assigned to Editor
09 Apr 2023Review(s) Completed, Editorial Evaluation Pending
20 Apr 2023Reviewer(s) Assigned
10 May 2023Editorial Decision: Revise Major
31 Jul 20231st Revision Received
31 Jul 2023Submission Checks Completed
31 Jul 2023Review(s) Completed, Editorial Evaluation Pending
31 Jul 2023Assigned to Editor
31 Jul 2023Reviewer(s) Assigned
10 Aug 2023Editorial Decision: Accept