RECURRENT THORACIC AIR LEAK SYNDROME IN PATIENTS AFFECTED BY PULMONARY
GRAFT-VERSUS-HOST DISEASE: SURGICAL STRATEGIES AND OUTCOME
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.