Pleural effusions in lung transplant recipients: image-guided small-bore catheter drainage.

PURPOSE: To assess the efficacy of treating pleural effusions in lung transplant recipients with small-bore catheter drainage. MATERIALS AND METHODS: Chest radiographs and computed tomographic (CT) scans obtained in 31 lung transplant recipients who had pleural effusions treated with catheter drainage were retrospectively reviewed. Duration of drainage and volume of fluid drained were recorded. Results were evaluated 1 and 3 months after chest tube removal. There was complete response (CR) when no pleural fluid remained, partial response (PR) when fluid remaining was less than the pretreatment level, and no response (NR) when fluid recurred to a level at or above the pretreatment level. Associations between cause of effusion (empyema, parapneumonic effusion, rejection, other), response (CR, PR, NR), and type of transplantation (unilateral, bilateral) were examined by using chi2 tests. RESULTS: Of 31 patients, 25 had bilateral effusions; eight of these 25 patients had small-bore catheters inserted bilaterally. Nine patients had multiple sequential catheter insertions. Duration of drainage ranged from 2 to 44 days (median, 6 days). Fluid output was 110-9,726 mL (median, 1,350 mL). One-month follow-up data were available for 31 of 39 treated pleural effusions: 11 (35%) had CR, 18 (58%) had PR, and two (6%) had NR (percentages do not add up to 100% due to rounding). Three-month follow-up data were available for 28 of 39 treated effusions: 22 (79%) had CR, five (18%) had PR, and one (4%) had NR (percentages do not add up to 100% due to rounding). One- and 3-month response rates, respectively, were not related to cause of effusion (P =.82 and.535) or type of transplantation (P =.568 and >.999). CONCLUSION: Small-bore catheter drainage of persistent pleural effusions in lung transplant recipients is usually successful, but drainage is often prolonged and may require multiple catheter placements.

Duke Scholars

Author Scott Michael Palmer Jr. Medicine, Pulmonary, Allergy, and Critical Care Medicine

Author James Emmett Herndon II Biostatistics & Bioinformatics, Division of Biostatistics

Author Holman Page McAdams Radiology, Cardiothoracic Imaging