Pleural Effusions Following Liver Transplantation: A Single-Center Experience

Abstract

Introduction: This was a single-center retrospective study to evaluate incidence, prognosis, and risk factors in patients with postoperative pleural effusions, a common pulmonary complication following liver transplantation. Methods: A retrospective review was performed on 374 liver transplantation cases through a database within the timeframe of January 1, 2009 through December 31, 2015. Demographics, pulmonary and cardiac function testing, laboratory studies, intraoperative transfusion/infusion volumes, postoperative management, and outcomes were analyzed. Results: In the immediate postoperative period, 189 (50.5%) developed pleural effusions following liver transplantation of which 145 (76.7%) resolved within 3 months. Those who developed pleural effusions demonstrated a lower fibrinogen (149.6 ± 66.3 mg/dL vs 178.4 ± 87.3 mg/dL; P = .009), total protein (5.8 ± 1.0 mg/dL vs 6.1 ± 1.2 mg/dL; P = .04), and hemoglobin (9.8 ± 1.8 mg/dL vs 10.3 ± 1.9 mg/dL; P = .004). There was not a statistically significant difference in 1-year all-cause mortality and in-hospital mortality between liver transplant recipients with and without pleural effusions. Liver transplant recipients who developed pleural effusions had a longer hospital length of stay (16.4 ± 10.9 days vs 14.0 ± 16.5 days; P = .1), but the differences were not statistically significant. However, there was a significant difference in tracheostomy rates (11.6% vs 5.4%; P = .03) in recipients who developed pleural effusions compared to recipients who did not. Conclusions: In summary, pleural effusions are common after liver transplantation and are associated with increased morbidity. Pre- and intraoperative risk factors can offer both predictive and prognostic value for post-transplantation pleural effusions. Further prospective studies will be needed to further evaluate the relevance of these findings to limit instances of postoperative pleural effusions.

Postoperative Trapped Lung After Orthotopic Liver Transplantation is a Predictor of Increased Mortality

“…Pulmonary complications following OLT are frequent and are associated with increased morbidity and mortality ( 4 – 6 , 8 , 11 ). While preoperative and early postoperative pleural effusions represent well-described and frequent complications of end-stage liver disease, published evidence about the clinical relevance and outcomes in patients with persistent pleural effusions after an OLT is scant ( 7 , 8 , 12 , 16 , 17 , 20 ). In this retrospective analysis, we investigated the clinical relevance of persistent pleural effusions with a specific focus on the risk factors for and complications related to TL, which we found is a common complication of persistent postoperative pleural effusions.…”

“…Prior work suggests that most pleural effusions following liver transplantation resolve within 1–3 months ( 8 , 20 ), but the significance of the remaining persistent effusions is less clear. Further, effusions complicated by TL may portend a different prognosis in comparison to those without TL.…”

Pleural effusion due to nonmalignant gastrointestinal disease

“…These cases were associated with increased morbidity. However, near 80% of cases were solved within the three first months [140]. The reason why PE occurs is unclear, but it may be caused by damage to the right diaphragm, as a result of the dissection and retraction of the right upper quadrant.…”

Implications of Pleural Fluid Composition in Persistent Pleural Effusion following Orthotopic Liver Transplant

“…Pleural effusion is a common complication of orthotopic liver transplant (OLT), reported to occur in 32% to 95% of cases within the first week after transplant [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. The majority of these effusions are thought to be caused by lymphatic disruption and diaphragmatic defects occurring during hepatectomy, leading to the transfer of fluid from ascites into the pleural space [ 9 , 10 ].…”

“…Among persistent pleural effusions, exudative effusions can occur with some regularity and up to one-fifth have micro-organisms identified on culture [ 1 ]. In contrast to transient pleural effusions, persistent effusions have been reported to portend worse outcomes, associated with atelectasis, pneumonia, and empyema [ 1 , 5 , 13 ]. Recurrent pleural effusions have also been associated with allograft rejection [ 11 ].…”