Pleural Space Complications Associated with Lung Transplantation

Arndt, Andrew; Boffa, Daniel J.

doi:10.1016/j.thorsurg.2014.09.005

Cited by 25 publications

(22 citation statements)

References 27 publications

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“…complications in the early post-operative phase after LTx. In a review article by Ahmad et al, pleural effusion occurred as a regular post-LTx condition, but with different causality [4]: Within the first two post-LTx weeks pleural effusion may appear as a consequence of severed pulmonary lymphatics related to the transplant procedure [25], while persistent pleural effusion during the later post-operative phase necessitates further diagnostics focusing on underlying parapneumonic effusion, pulmonary embolism, or acute heart failure [4]. In a prospective observational study, Wahidi et al found that 27 % had pleural effusion on post-LTx day seven [26].…”

Section: Lus Findingsmentioning

confidence: 99%

Lung Ultrasound in the Assessment of Pulmonary Complications After Lung Transplantation

et al. 2018

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Introduction Lung ultrasound (LUS) has a high diagnostic accuracy for identifying frequent conditions in the post-operative phase after lung transplantation (LTx). This study aimed to investigate the feasibility and clinical ability of LUS to identify pulmonary complications such as pleural effusions and pneumonias in the early postoperative phase after LTx. Methods A prospective cohort study of lung transplant recipients who consecutively underwent single LTx (SLTx) or double LTx (DLTx) at the National Lung Transplantation Center in Denmark from May 1 to October 31, 2015 was conducted. LUS was performed at four time points corresponding to post-transplant day 3, and weeks 2, 6, and 12 (LUS #1–4) to detect and monitor variation in pathological LUS findings over time. Concurrent with LUS #4, a high-resolution computed tomography examination of the thorax (HRCT) was also performed. Results 14 patients (1 SLTx/13 DLTx, 7 (50 %) women, mean age: 50.4 years) who had undergone the four prespecified LUS examinations were included. Pleural effusion was the most common condition and most pronounced at post-LTx week 2. Findings consistent with pneumonia increased during week 2 and subsequently decreased. Corresponding to LUS #1, 2, 3, and 4, pleural effusion occurred in 85.7 %, 92.9 %, 85.7 %, and 78.6 %, and pneumonia in 21.4 %, 28.6 %, 14.3 %, and 14.3 %, respectively. HRCT findings at post-LTx week 12 were predominantly presented by unspecific ground glass opacities. Conclusion In a post-LTx setting, LUS represents a clinical novelty as a feasible diagnostic and monitoring tool to identify pathological pulmonary complications in the early post-operative phase.

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Section: Lus Findingsmentioning

confidence: 99%

Lung Ultrasound in the Assessment of Pulmonary Complications After Lung Transplantation

et al. 2018

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“…LTx recipients have mechanical impairments including: 1) a fresh thoracotomy wound that creates thoracic cage abnormalities, 2) frequent phrenic nerve dysfunction, and 3) pleural dysfunction 28 . The bronchial anastomoses sites and the allograft airway mucosa are prone to ischemia, poor healing, infection and subsequent anastomotic airway complications 29 .…”

Section: Introductionmentioning

confidence: 99%

Mechanical ventilation for the lung transplant recipient

et al. 2015

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Mechanical ventilation (MV) is an important aspect in the intraoperative and early postoperative management of lung transplant (LTx)-recipients. There are no randomized-controlled trials of LTx-recipient MV strategies; however there are LTx center experiences and international survey studies reported. The main early complication of LTx is primary graft dysfunction (PGD), which is similar to the adult respiratory distress syndrome (ARDS). We aim to summarize information pertinent to LTx-MV, as well as PGD, ARDS, and intraoperative MV and to synthesize these available data into recommendations. Based on the available evidence, we recommend lung-protective MV with low-tidal-volumes (≤6 mL/kg predicted body weight [PBW]) and positive end-expiratory pressure for the LTx-recipient. In our opinion, the MV strategy should be based on donor characteristics (donor PBW as a parameter of actual allograft size), rather than based on recipient characteristics; however this donor-characteristics-based protective MV is based on indirect evidence and requires validation in prospective clinical studies.

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“…‐ 17 Pleural scarring in the context of asbestosis was associated with a decreased lung function 18,19 . We hypothesize that the high rate of residual pleural thickening after effusions in LTx patients 2,4 is mechanistically linked to the decreased pulmonary function observed in our study. The high rate of residual pleural thickening may reflect the high rate of exudates seen by our group and others 7,9 .…”

Section: Discussionmentioning

confidence: 66%

“…Pleural space complications are a common phenomenon after LTx 2–4 . Among these, pleural effusions are by far the most prevalent 3 and can occur for a variety of reasons.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Characteristics and clinical implications of pleural effusions after lung transplantation: A retrospective analysis of 195 thoracocenteses in 113 patients

Joean

Kayser

Valtin

et al. 2021

Clinical Transplantation

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Despite advances in lung transplantation (LTx), morbidity, and mortality are high. We hypothesized that pleural effusions requiring thoracocentesis lead to poor outcomes after LTx. We performed a single‐center retrospective analysis of thoracocenteses after initial hospital discharge in LTx patients between March 2008 and September 2020 to identify risk factors, etiologies, and outcomes. Of the 1223 patients included, 113 patients (9.2%) required a total of 195 thoracocenteses. The cumulative incidence of thoracocentesis was 10.6% at 1 year and 14.2% at 5 years after transplantation. We observed a bimodal distribution of pleural effusion onset with a threshold at 6 months. Late‐onset effusions were mostly of malignant or cardiac origin. We observed a high rate of nonspecific effusions (41.5%) irrespective of the timepoint post‐transplantation. Patients with late‐onset effusions had significantly lower survival compared to a matched controlled group (HR 2.43; 95% CI (1.27–4.62). All pulmonary function parameters were significantly decreased in patients requiring thoracocentesis compared to matched controls. Male sex and re‐transplantation were risk factors for pleural effusions. In conclusion, pleural effusions requiring thoracocentesis occur frequently in LTx patients and lead to a reduced long‐term allograft function. Late‐onset effusions are associated with a lower survival.

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Pleural Space Complications Associated with Lung Transplantation

Cited by 25 publications

References 27 publications

Lung Ultrasound in the Assessment of Pulmonary Complications After Lung Transplantation

Lung Ultrasound in the Assessment of Pulmonary Complications After Lung Transplantation

Mechanical ventilation for the lung transplant recipient

Characteristics and clinical implications of pleural effusions after lung transplantation: A retrospective analysis of 195 thoracocenteses in 113 patients

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