Safety of peritoneal and pleural drain placement in pediatric stem cell transplant recipients with severe veno‐occlusive disease

Abstract

Hepatic VOD (veno-occlusive disease) is a serious complication of HSCT (hematopoietic stem cell transplantation) and has historically been associated with high mortality. This obstruction to hepatic flow often results in fluid collections in the peritoneal and pleural cavities. Catheter placement to drain ascites or pleural fluid may reduce intra-abdominal hypertension and/or improve respiratory parameters. The safety of these interventions among critically ill, immunocompromised children is unknown. Among 32 HSCT recipients (2000-2012) with severe VOD, we assessed the primary outcome of procedural complication from peritoneal drain placement. Twenty-four (75%) patients underwent peritoneal drain placement. No patient sustained visceral perforation or hemorrhage with drain placement. Overall mortality was 47% (n = 15). The procedure was not associated with increased overall mortality (p > 0.99). Eight (25%) peritoneal drains required replacement for malfunction. Of 24 patients with peritoneal drains, one (4%) patient had a positive culture from ascitic fluid. Eight (25%) patients underwent pleural drain placement. No pleural drain-related procedural complication or infection occurred. Four (50%) of the eight patients with pleural drains had de-escalation in oxygen requirement at drain removal, compared to time of placement. In this study, peritoneal and pleural drains were safe interventions for children with severe VOD.

The role of peritoneal drainage in veno-occlusive disease in pediatric patients post hematopoietic stem cell transplant

“…Ascites develops in 20-80% of children with SOS/VOD and can result in severe morbidity [3,4]. Progressive ascites increases risks of respiratory compromise due to abdominal competition, and renal compromise due to compression of renal vasculature.…”

“…There is little data on the use and safety of interventional strategies, including PD, for prevention of MOF. A study by Madenci et al [4]. evaluated the safety of peritoneal and pleural drain placement in pediatric HSCT recipients with severe SOS.…”

“…The incidence of SOS/VOD in children after HSCT varies widely in reports, ranging from 8 to 60% [1,4,5]. The diagnosis is typically made by clinical observations as outlined by the Baltimore or the modified Seattle criteria [6,7].…”

“…Drainage of ascites can improve respiratory excursion and prevent renal injury from intra-abdominal hypertension and impaired renal perfusion, but is not standard of care [8]. A recent retrospective study by Madenci et al [4]. reviewed the safety of pleural and peritoneal drain placement in pediatric HSCT patients with severe SOS/VOD.…”