For various reasons, liver recipients are frequently affected by pleural effusions in the postoperative phase. Besides high volume turn over and low serum albumin, local irritation at the diaphragm leads towards fluid collection in the right hemi-thorax. The purpose of this study was to evaluate the prevalence and complications of drainage requiring pleural effusions after liver transplantation (LTx).

The years 2009 to 2016 were analyzed retrospectively. The indication for interventional therapy of the pleural effusion was oxygenation problems or pneumonia prophylaxis.

In the transplantation center Charité – Berlin 375 out of 576 patients (62%) had at least one pleural drainage placed within the first 10 days after transplantation. Patients with a MELD score >20 were mostly affected (76% vs 54%, p < 0.01). Typically, drainages were performed at the ICU (60%) whereas the rest was done in the operating room at the time of transplantation (13,5%), prior transplantation (9%), via CT puncture (0,9%) or in the context of reoperations (9,2%). 96% received a thoracic catheter on the right side presumably caused by local irritations, 4% had an isolated pleural drainage on the left side. Due to liver-disease related pathophysiology one third of all patients needed pre interventional optimization of coagulation via thrombocytes, fresh frozen plasma or prothrombin complex concentrate. Out of 375 patients receiving an intercostal drain 14 (3,7%) suffered from hemorrhage and 6 (1.6%) from pneumothorax requiring further medical treatment. According to Clavien-Dindo classifications 6 patients were II[deg], 11 patients IIIA[deg] and 3 patients required surgery in ITN classified as IIIB[deg].When comparing the time point/localization of the drainage placement a tendency towards less complications could be observed when performed during the transplantation as compared to the postoperative application on the ICU (1/68 (1,5%) vs 18/236 (7,6%); p=0.064).

Pleural effusion, more frequent in patients with higher MELD, is a common complication after LTx requiring intervention in most cases. Routinely placed intraoperative chest tubes may reduce complications and avoid unnecessary coagulation products in high risk patients.

CITATION INFORMATION: Ritschl P., Wiering L., Sponholz F., Brandl A., Aigner F., Biebl M., Schmelzle M., Eurich D., Sauer I., Kotsch K., Pratschke J., Öllinger R. Preemptive Chest Tube in Liver Transplantation – An Unconventional Way to Reduce Morbidity Am J Transplant. 2017;17 (suppl 3).

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