Biological alternatives to chemical pleurodesis: Evaluation of autologous blood, platelet-rich plasma and platelet-rich fibrin in an experimental rat model.

Background: Pleurodesis is a widely used technique in thoracic surgery aimed at preventing the recurrence of pleural effusion and pneumothorax. Although chemical sclerosing agents such as talc are effective, their use is often limited by significant adverse effects, prompting interest in safer and more biocompatible alternatives. This experimental study evaluates the pleurodesis-inducing potential of three autologous biological agents-autologous blood (AB), platelet-rich plasma (PRP), and injectable platelet-rich fibrin (i-PRF)-in a rat model. Methods: Twenty-eight adult Wistar albino rats were randomly divided into four groups: control (saline), AB, PRP, and i-PRF. Each agent was administered intrathoracically, and the animals were observed over a 21-day period. Subsequently, pleural and pulmonary tissues were examined histopathologically. Results: PRP induced the most pronounced pleurodesis response, with significant pleural thickening, extensive fibrous adhesions, and dense collagen deposition. i-PRF, though less potent than PRP, showed a biocompatible and structurally organized fibrotic effect, with moderate collagen formation and minimal inflammation. AB elicited a modest, inconsistent pleurodesis response, with limited fibrotic remodeling. Conclusion: These findings suggest that platelet-based products, particularly PRP, may serve as effective and physiologically compatible alternatives to conventional chemical agents in pleurodesis. Furthermore, i-PRF represents a promising candidate in scenarios where minimizing inflammation is critical. This study is the first to evaluate i-PRF in pleurodesis and supports its potential translational application. Further clinical studies are warranted to validate these findings in human subjects.