J. W. Clouse1, C. A. Kubal1, A. N. Blumenthaler1, R. S. Mangus1 1Indiana University School Of Medicine,Transplant/Surgery,Indianapolis, IN, USA
Background
Pulmonary complications after liver transplantation have previously been associated with longer hospital stays, increased time on a ventilator, and higher mortality. This study reports the incidence and outcomes of a specific pulmonary complication, pleural effusion, in orthotopic liver transplant recipients at an active transplant center.
Methods
Records from a single transplant center were analyzed retrospectively for all adult patients (>17 years of age) receiving a liver transplant over a four year period from July 2013 through June 2017. Radiologic reports were used to diagnose pleural effusions and determine therapeutic interventions. Patients with documented pleural effusion by radiographic imaging within 30 days pre- or post-transplant were considered as cases for the analysis with those not having an effusion being non-cases. Outcomes included length of hospital stay, discharge disposition, hospital readmission, and discharge with home oxygen. Patient survival is assessed using Cox regression survival modeling.
Results
During the study period, 512 liver transplants were performed, with 102 patients (20%) developing a peri-transplant pleural effusion. In total, 47 patients (9%) had a pre-transplant effusion, 87 (17%) had a post-transplant effusion, and 32 (6%) had both. Factors associated with the presence of any pleural effusion included an increasing MELD score, retransplantation, and a diagnosis of alcoholic liver disease. Median hospital stay for patients with any effusion was 17 days, compared to 10 days for patients with no effusion. Of the patients with pleural effusion, 48% either died in the hospital or required admission to a rehabilitation facility at discharge (52% discharged to home). Readmission to the hospital within 90-days of discharge occurred in 69% of effusion patients. Cox regression analysis showed decreased survival among patients who developed pleural effusion at 12, 24, and 36 months post-transplant.
Conclusion
Overall 20% of liver transplant recipients developed a peri-transplant pleural effusion. In this patient population, pleural effusion significantly decreases life-expectancy post-transplant. Risk factors for the development of pleural effusion included higher MELD score (>20), retransplantation, and alcoholic liver disease.
