{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:48:36Z","timestamp":1792511316891,"version":"4.5.0"},"reference-count":29,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T00:00:00Z","timestamp":1693180800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>Thoracic air leak syndrome (TALS) is a complication related to chronic pulmonary graft\u2010versus\u2010host disease (pGvHD) that affects approximately 0.83%\u22123.08% 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\u2010transplant survival. The aim of the present study is to describe a single\u2010center experience in the surgical management of recurrent TALS in adolescents and young adults and its outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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. We analyzed clinical data, number of episodes of thoracic air leak, surgical procedures and relative outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the examined period, four patients, aged 16\u221225 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\u2013513). These patients experienced on average 4.5 air leak episodes (range 3\u20136). 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\u2013477). Pulmonary function progressively deteriorated, and all the patients eventually died because of respiratory failure after a mean time of 483 days (range 127\u20131045) after the first episode of air leak.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Surgery provides temporary relief to symptoms related to TALS but has limited effects on the underlying pathophysiologic process. The development of TALS in a sign of progressive pulmonary function worsening and is associated with high risk of respiratory failure and mortality.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.26645","type":"journal-article","created":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T05:45:37Z","timestamp":1693287937000},"page":"3206-3212","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Recurrent thoracic air leak syndrome in patients affected by pulmonary graft\u2010versus\u2010host disease: Surgical strategies and outcome"],"prefix":"10.1002","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8093-2726","authenticated-orcid":false,"given":"Giorgio","family":"Persano","sequence":"first","affiliation":[{"name":"Surgical Oncology Unit\u2014General and Thoracic Surgery Unit Bambino Ges\u00f9 Children's Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Crocoli","sequence":"additional","affiliation":[{"name":"Surgical Oncology Unit\u2014General and Thoracic Surgery Unit Bambino Ges\u00f9 Children's Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Martucci","sequence":"additional","affiliation":[{"name":"Surgical Oncology Unit\u2014General and Thoracic Surgery Unit Bambino Ges\u00f9 Children's Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Pardi","sequence":"additional","affiliation":[{"name":"Surgical Oncology Unit\u2014General and Thoracic Surgery Unit Bambino Ges\u00f9 Children's Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pier Luigi","family":"Di Paolo","sequence":"additional","affiliation":[{"name":"Radiology Unit, Department of Diagnostic Imaging Bambino Ges\u00f9 Children's Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3673-4845","authenticated-orcid":false,"given":"Francesca","family":"Petreschi","sequence":"additional","affiliation":[{"name":"Bronchopneumology Unit, Academic Department of Pediatrics Bambino Ges\u00f9 Children's Hospital, IRCCS  Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Cafiero","sequence":"additional","affiliation":[{"name":"Sport and Hypertension Medicine Unit, Department of Cardiac Surgery, Cardiology, Heart and Lung Transplant Bambino Ges\u00f9 Children's Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Inserra","sequence":"additional","affiliation":[{"name":"Surgical Oncology Unit\u2014General and Thoracic Surgery Unit Bambino Ges\u00f9 Children's Hospital IRCCS Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2013.11.025"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2010.11.018"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2009.11.002"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/RTI.0b013e3180cab6cf"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2010.25.5.658"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2010.129"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.55.4539"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-48308-9"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1704491"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2006.07.013"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2014.12.001"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-019-03482-w"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.120.2.543"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.rct.0000187416.07698.8d"},{"issue":"2","key":"e_1_2_8_16_1","first-page":"111","article-title":"Forced expiratory flow at 25%\u201075% links COPD physiology to emphysema and disease severity in the SPIROMICS cohort","volume":"9","author":"Ronish BE","year":"2022","journal-title":"Chronic Obstr Pulm Dis (Miami, Fla.)"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.5152\/dir.2016.15516"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201308-1483ST"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-019-04405-5"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2022.05.027"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-020-00871-1"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201601-022OC"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11748-018-01057-4"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2014.06.047"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2020.11.012"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-017-1597-4"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2014.06.014"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0b013e31829b7f58"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2015.02.024"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2018.03.002"}],"container-title":["Pediatric Pulmonology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ppul.26645","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:50:54Z","timestamp":1740617454000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ppul.26645"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,28]]},"references-count":29,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1002\/ppul.26645"],"URL":"https:\/\/doi.org\/10.1002\/ppul.26645","archive":["Portico"],"relation":{},"ISSN":["8755-6863","1099-0496"],"issn-type":[{"value":"8755-6863","type":"print"},{"value":"1099-0496","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,28]]},"assertion":[{"value":"2023-04-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}