Incidence, Management, and Outcomes of Chylothorax after Lung Transplantation: A Single-center Experience

Abstract

Background The objective of this study was to determine the incidence and outcomes of chylothorax after lung transplantation. Methods We conducted a retrospective review of our institutional lung transplant registry of 504 adult transplantations done from 2001 to 2015 and identified seven patients (1.38%) with chylothorax. Electronic health records were then analyzed to determine demographics, indications for surgery, management, and outcomes. Survival curves were plotted using the Kaplan-Meier method. Results Chylothorax presented in the first week in four (62.5%) patients, and approximately one month later in the remaining three. Nonsurgical management was initially attempted in all patients and succeeded in three (42.9%). Elective surgical ligation of the thoracic duct (LTD) was successful in two (66.7%) out of three patients in whom it was performed. One patient required emergent reoperation for clamshell thoracotomy dehiscence from severe chylothorax. Thoracic duct embolization was attempted but unsuccessful in two patients. Subsequently, one of these patients received a peritoneal-venous shunt and the other underwent LTD. Chylothorax permanently resolved in six patients (85.7%). There were no mortalities directly related to chylothorax. The median time to resolution was 11 days (range: 7-60). The mean survival in months for chylothorax patients was 29.2 (SE 3.1) and 78.2 (SE 2.9) for the remaining patients ( p = 0.37). The median survival was not reached for the chylothorax group and was 71.8 months (95% CI: 58.0-83.9) for the rest. Conclusion Chylothorax is rare after lung transplantation but can lead to major comorbidities and prolonged hospital stay. In our experience, nonsurgical management was successful in up to 40% of patients. LTD should be considered in those who fail conservative management.

Postoperative management and acute complications after lung transplantation

“…Pleural space conditions that require intervention are seen in up to 22% of lung transplant procedures (54). Conditions like pleural effusion and pneumothorax are commonly seen, whereas empyema and chylothorax are much less common (57). Symptomatic pneumothorax or when >5% of the hemithorax volume is managed by percutaneous pigtail catheter placement under ultrasound or CT guidance.…”

Early postoperative complications in lung transplant recipients

“…Uncomplicated effusions usually resolve within 2 weeks [ 33 , 34 ]. Complicated effusions are associated with poor patient outcomes [ 31 , 32 , 35 ] and occur more commonly in double lung transplant recipients [ 32 ]. The incidence of hemothorax is between 12 and 18% with a trend towards increase in sarcoidosis and re-transplantations [ 31 , 36 , 37 ].…”

“…Chylothorax occurs due to interruption of the thoracic duct and leakage of chyle into the pleural space. In a case series, 7 of 504 (1.38%) patients developed chylothorax, 5 of which had underlying pulmonary fibrosis [ 35 ]. Dietary modifications with low-fat, medium-chain-triglyceride diet or total parenteral nutrition along with chest tube drainage and octreotide were insufficient for treatment and most required surgical intervention [ 35 ].…”

Aggressive Management of a Bilateral Chylothorax Complicating an Orthotopic Heart-Kidney Transplantation

“…It is well-documented that chylothorax management remains a challenge because there are no universally accepted protocols for management [ 8 , 9 , 10 ] . Jacob et al [ 10 ] proposed an algorithm for chylothorax management among lung transplant recipients.…”