Reassessing delayed chest closure in lung transplantation: Outcomes from a propensity score-matched cohort.

Authors

Andrew Keogan, Mark Shacker, Artur Rybachok, Lucia Chang, Lucas Wang, Theodore Lin, Sreeja Biswas Roy, Ashwini Arjuna, Rajat Walia, Samad Hashimi, Ross M Bremner, Lara W Schaheen, Jasmine Huang, Michael A Smith

Published in

JTCVS open. Volume 32. Pages 101828. Epub Apr 20, 2026.

Abstract

Delayed chest closure (DCC) is a strategy for managing complex lung transplantation cases. We compared the influences as well as short- and long-term outcomes of DCC to those of primary chest closure (PCC).
We retrospectively analyzed lung transplantation procedures between September 15, 2014, and February 25, 2024, at a single center, excluding single-lung, redo, and multiorgan cases. Propensity score matching balanced donor, recipient, and intraoperative factors. Outcomes and survival were evaluated using univariable/multivariable and Kaplan-Meier analyses, respectively.
Of 692 patients, 127 (18%) underwent DCC and 565 (82%) underwent PCC; 86 well-matched pairs were generated. Factors independently associated with DCC included increasing mean pulmonary artery pressure at registration (adjusted odds ratio [aOR], 1.028; 95% CI, 1.002-1.056; P = .038), extracorporeal membrane oxygenation bridge to transplant (aOR, 2.796; 95% CI, 1.138-6.869; P = .025), donation after circulatory death allograft (aOR, 3.263; 95% CI, 1.620-6.571; P < .001), cardiopulmonary bypass during transplant (aOR, 2.613; 95% CI, 1.454-4.696; P = .001), greater transfusion volume (aOR, 1.354 per unit of packed red blood cells; 95% CI, 1.233-1.487; P < .001), and prolonged ischemic time (aOR, 1.192 per hour; 95% CI, 1.063-1.336; P = .003). Postoperatively, DCC recipients experienced higher rates of grade 3 primary graft dysfunction at 72 hours (49% vs 23%; P = .008), mechanical ventilation at 72 hours, extracorporeal membrane oxygenation use, tracheostomy, prolonged ventilatory support, dialysis, and longer hospitalizations (all P values < .05). Rates of sternal disunion, empyema, and unplanned return to operating room (all P values > .3) and overall survival (P = .505) were comparable between groups.
Well-matched patients who underwent DCC or PCC had comparable rates of pleural space infection, sternal nonunion, and overall survival, although DCC patients had higher rates of early postoperative morbidity.

PMID:
42604315
Bibliographic data and abstract were imported from PubMed on 16 Aug 2026.

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