Characteristics and clinical implications of pleural effusions after lung transplantation: A retrospective analysis of 195 thoracocenteses in 113 patients

Abstract

Despite advances in lung transplantation (LTx), morbidity, and mortality are high. We hypothesized that pleural effusions requiring thoracocentesis lead to poor outcomes after LTx. We performed a single‐center retrospective analysis of thoracocenteses after initial hospital discharge in LTx patients between March 2008 and September 2020 to identify risk factors, etiologies, and outcomes. Of the 1223 patients included, 113 patients (9.2%) required a total of 195 thoracocenteses. The cumulative incidence of thoracocentesis was 10.6% at 1 year and 14.2% at 5 years after transplantation. We observed a bimodal distribution of pleural effusion onset with a threshold at 6 months. Late‐onset effusions were mostly of malignant or cardiac origin. We observed a high rate of nonspecific effusions (41.5%) irrespective of the timepoint post‐transplantation. Patients with late‐onset effusions had significantly lower survival compared to a matched controlled group (HR 2.43; 95% CI (1.27–4.62). All pulmonary function parameters were significantly decreased in patients requiring thoracocentesis compared to matched controls. Male sex and re‐transplantation were risk factors for pleural effusions. In conclusion, pleural effusions requiring thoracocentesis occur frequently in LTx patients and lead to a reduced long‐term allograft function. Late‐onset effusions are associated with a lower survival.

Safety and utility of indwelling pleural catheters in lung transplant recipients

“…Moreover, we show that IPCs do not need to remain in situ for a protracted time period; in our cohort IPCs led to efficacious results in a median time of 41 days, less than half the time seen in comparison groups 9,13 . Given that the incidence of pleural effusions following lung transplantation is ∼15%–25%, and many patients require hospital admission and multiple procedures to obtain a resolution, a change in paradigm with increased use of IPCs would be impactful 17,28,29 …”

“…9,13 Given that the incidence of pleural effusions following lung transplantation is ∼15%-25%, and many patients require hospital admission and multiple procedures to obtain a resolution, a change in paradigm with increased use of IPCs would be impactful. 17,28,29 We present the largest multicenter study of IPCs examining rate of complications and rate of achieving pleurodesis in lung allograft recipients. Although infection was the most common complication in this cohort, the rate of infection was similar to reported IPC infection rates in other etiologies and was treated successfully in all patients, without mortality.…”

Roles of electrical impedance tomography in lung transplantation

“…It is common for lung transplant recipients to have a drainage tube placed in the chest in the postoperative period (Joean et al, 2021).…”

“…Since the technique only shows a variation in impedance, the affected area was no longer ventilated after pneumothorax, and the ventilation image was lost ( Morais et al, 2017 ). Pleural effusions are prevalent phenomena after transplantation ( Joean et al, 2021 ). Moreover, the validity in evaluating pleural effusion and emptying was also presented in EIT ( Omer et al, 2021 ).…”

“…Strict disinfection of the electrode belt at each operation may be beneficial for this problem. It is common for lung transplant recipients to have a drainage tube placed in the chest in the postoperative period ( Joean et al, 2021 ). Excessive pleural effusion and severe pneumothorax may limit ventilation and affect the accuracy of ventilation assessment in EIT imaging of lung transplantation ( Becher et al, 2018 ; Rara et al, 2020 ).…”