Pleural complications are noticed after lung transplantation (LT). However, long term implications of pleural effusions (PE) are unknown. The purpose of this study was to evaluate the characteristics of pleural effusions that develop after 14 days of LT and the impact of PE on long term survival.
Retrospective chart review of all patients who received LT at Henry Ford Health System between October, 1994 and January, 2008 was done. Allograft recipients who developed PE at 14 days or more after transplantation were identified. Thereafter, the characteristics of the effusions were determined. Associated acute rejection, infection, both or other risk factors were identified as the cause of effusion. Implications of effusions developing within the first 90 postoperative days on survival were studied.
110 charts were reviewed. 36% of allograft recipients developed PE following LT. The median time for onset of effusions was 47 days. The mean age of patients who developed effusions was 55 years. The predominant underlying disease was Chronic Obstructive Pulmonary Disease (71%). 63% of the patients who developed effusions had single lung transplantation (SLT). Most of the effusions in patients with SLT occurred in those with left SLT (71%). 84% of effusions were exudates. Associated risk factors are infections (34%), acute rejection (18%) while 26% had no associated acute rejection or infection. The median survival for those who developed PEs within 90 postoperative days significantly worse (26 months), while those who did not develop PE had a median survival of 52 months.
PE are more common with SLT. Among SLT, left SLT tend to have increasing pleural effusions. A significant percentage (26%) had no ongoing acute rejection or infection associated with pleural effusions. Allograft recipeints with effusions had worse survival.
The results of this pilot study indicate that PE post LT have significant impact on survival. Larger studies are needed to further elucidate the impact of PE on post transplant outcomes.
Luis Pena-Hernandez, No Financial Disclosure Information; No Product/Research Disclosure Information