PURPOSE: Persistent pleural effusions after lung transplantation (LTx) can lead to lung entrapment and respiratory compromise. Decortication for entrapment carries considerable morbidity and mortality. Percutaneous drains and chest tubes are uncomfortable and can be kept in place for limited periods of time before removal is mandated. The PleurX® is easily placed, is well tolerated, and designed for extended use. We analyzed our PleurX® catheter experience with specific endpoints of 1) lung expansion and 2) successful treatment of effusion after LTx.
METHODS: 139 patients underwent LTx at Cleveland Clinic between March 1, 2006 and February 29, 2008. Retrospective review of medical records was performed and LTx patients treated with PleurX® catheters [Denver Biomedical, Golden, CO] identified after Institutional Review Board approval. Patient demographics, indications for placement, timing between catheter placement and removal as well as catheter related complications were evaluated with specific endpoints of lung expansion and resolution of effusion.
RESULTS: 11 PleurX® catheters were placed in 8 patients (5 unilateral, 3 bilateral). There was no perioperative mortality. 5/8 patients had idiopathic pulmonary fibrosis as their indication for LTx, 2/8 emphysema and 1/8 bronchiectasis. The indication for catheter placement was refractory pleural effusion after failed conventional therapy in all 11 patients. 73% (8/11) also had concomitant lung entrapment diagnosed either preoperatively or at the time of catheter placement. Median time from LTx to catheter placement was 79 days [range: 21–769]. Catheters were maintained for a median of 90 days [range: 37–101]. Catheter-related complications included delayed hemothorax in an anticoagulated patient (1) and catheter-related empyema (1). Impresssively, PleurX® catheters achieved both lung expansion and resolution of effusion in 82% (9/11).
CONCLUSION: PleurX® catheters can be safely placed and maintained in patients after LTx. They are surprisingly effective in the management of difficult-to-control pleural effusions after other strategies have failed.
CLINICAL IMPLICATIONS: PleurX® catheter placement is a minimally invasive strategy that should be added to the armamentarium of techniques used to manage complex pleural space problems after LTx.
DISCLOSURE: Nakul Vakil, No Financial Disclosure Information; No Product/Research Disclosure Information