*Purpose: 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 adult (>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, discharge with home oxygen, and 1-year survival.

*Results: During the study period, 512 liver transplants were performed, with 107 patients (21%) developing a peri-transplant pleural effusion. In total, 49 patients (10%) had a pre-transplant effusion, 91 (18%) 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. Nutritional factors including serum albumin and protein and level of sarcopenia were all significant predictors of effusion. Median hospital stay for patients with any effusion was 17 days (vs 9 days no effusion, p<0.001) and were more likely to be discharged to a care facility (48% vs 21%, p<0.001). Readmission within 90-days occurred in 69% of effusion patients (vs 44% no effusion, p<0.001). Survival at 1-year for patients with any effusion was 86% (vs 94% no effusion, p<0.01).

*Conclusions: Overall 20% of liver transplant recipients developed a peri-transplant pleural effusion. In this patient population, pleural effusion is associated with a significantly decreased survival. Risk factors for the development of pleural effusion included higher MELD score (>20), retransplantation, alcoholic liver disease, and poor nutrition status and low muscle mass.

« Back to 2019 American Transplant Congress