Chylothoraces After Lung Transplantation for Lymphangioleiomyomatosis: Review of the Literature and Utilization of a Pleurovenous Shunt

Fremont, Richard D.; Light, Richard W.; Ninan, Mathew

doi:10.1016/j.healun.2007.07.008

Cited by 23 publications

(15 citation statements)

References 14 publications

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“…Figure 1 presents a flowchart showing the complete breakdown of the steps used in the identification of appropriate studies [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,…”

Section: Resultsmentioning

confidence: 99%

“…Lung transplantation (unilateral or bilateral) was performed in 7 patients with poor response in all cases [44,52,79,94,101], although in 1 case the disease took 5 years to reappear [79]. In another case, chylothorax appeared after bilateral lung transplant [76]. PE was not treated in 7 cases [16,20,28,44,57,69], and the choice of treatment was not specified in another 75 patients with PE.…”

Section: Resultsmentioning

confidence: 99%

“…Cytology and culture of PE were negative in all cases. In 44 of 69 patients (63.8%) in whom ascites was described, PE was accompanied by this condition [9,11,16,17,18,24,26,28,30,39,48,52,55,58,63,64,65,68,73,75,76,78,82,84,85,86,88,95], and in 97.3% (36/37) of the cases it was chylous. The only case of nonchylous ascites corresponded to the already mentioned patient that had a hemiperitoneum and a serous-hematic PE [48].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in a series of 13 patients (only 3 chylothorax), all had posttransplant complications [52], and in another patient, chylothorax appeared after a double lung transplant [76]. Treatments with luteinizing hormone [58], triptorelin [60], tamoxifen [84], octreotide [87,94], or chylovenous shunt [39,76] seem rather anecdotal since the number of cases in which they have been used is very small, and in general results have not been good. Spontaneous improvement of chylothorax has also been described [31].…”

Section: Discussionmentioning

confidence: 99%

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Characteristics of Patients with Lymphangioleiomyomatosis and Pleural Effusion: A Systematic Review

et al. 2016

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The characteristics of patients with lymphangioleiomyomatosis (LAM) are poorly defined, as they may present with or without pleural effusion (PE). We performed a systematic review across four electronic databases searching for studies reporting clinical findings, PE characteristics, and the most effective treatment of LAM. Case descriptions and retrospective studies were included, unrestricted by year of publication. The review consisted of 94 studies (199 patients) spanning a period of nearly 55 years. The median age was 38 years (range: 1 month to 69 years), and 79.7% were between 21 and 50 years old. All cases had dyspnea, 95% had a cough, and 87.5% had chest pain. PE was exudative chylothorax, usually unilateral (76%) and right-sided, predominantly lymphocytic, and with proportionately higher levels of proteins than lactate dehydrogenase. Sirolimus was effective in all cases, completely in 87%, and partially in 13%, although the number of patients receiving sirolimus was small. The present study confirmed that LAM and PE mainly occur in women of childbearing age (third to fifth decade of life). PE was usually unilateral and presented as a lymphocyte-predominant chylous exudate. The most effective treatment for PE seems to be sirolimus, although studies with larger series are needed to confirm this.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Characteristics of Patients with Lymphangioleiomyomatosis and Pleural Effusion: A Systematic Review

et al. 2016

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“…8 The consequences of chylothorax among lung transplant patients mirror those in other patients and include malnutrition, electrolyte abnormalities, and immune suppression from the ongoing loss of lymphatic fluid. 9 The immunosuppressive effects are of particular importance in this population and may lead to a need for immunosuppressant dose adjustment. 10 Typically a trial of bowel rest is initiated to evaluate for spontaneous resolution of chyle leak.…”

Section: Chylothoraxmentioning

confidence: 99%