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Pleural Effusions in Lung Transplant Recipients: Image-guided Small-Bore Catheter Drainage¹

¹ From the Departments of Radiology (E.M.M., H.P.M.), Medicine (S.M.P.), Biostatistics and Bioinformatics (J.E.H.), and Cancer Center Biostatistics (J.E.H., C.Z.), Duke University Medical Center, Durham, NC; and Department of Radiology, M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 57, Houston, TX 77030 (E.M.M., J.J.E.). Received July 12, 2002; revision requested August 23; revision received September 26; accepted November 18. Address correspondence to E.M.M. (e-mail: emarom@di.mdacc.tmc.edu).

PURPOSE: To assess the efficacy of treating pleural effusions in lung transplant recipients with small-bore catheter drainage.

MATERIALS AND METHODS: Chest radiographs and computed tomographic (CT) scans obtained in 31 lung transplant recipients who had pleural effusions treated with catheter drainage were retrospectively reviewed. Duration of drainage and volume of fluid drained were recorded. Results were evaluated 1 and 3 months after chest tube removal. There was complete response (CR) when no pleural fluid remained, partial response (PR) when fluid remaining was less than the pretreatment level, and no response (NR) when fluid recurred to a level at or above the pretreatment level. Associations between cause of effusion (empyema, parapneumonic effusion, rejection, other), response (CR, PR, NR), and type of transplantation (unilateral, bilateral) were examined by using ² tests.

RESULTS: Of 31 patients, 25 had bilateral effusions; eight of these 25 patients had small-bore catheters inserted bilaterally. Nine patients had multiple sequential catheter insertions. Duration of drainage ranged from 2 to 44 days (median, 6 days). Fluid output was 110–9,726 mL (median, 1,350 mL). One-month follow-up data were available for 31 of 39 treated pleural effusions: 11 (35%) had CR, 18 (58%) had PR, and two (6%) had NR (percentages do not add up to 100% due to rounding). Three-month follow-up data were available for 28 of 39 treated effusions: 22 (79%) had CR, five (18%) had PR, and one (4%) had NR (percentages do not add up to 100% due to rounding). One- and 3-month response rates, respectively, were not related to cause of effusion (P = .82 and .535) or type of transplantation (P = .568 and >.999).

CONCLUSION: Small-bore catheter drainage of persistent pleural effusions in lung transplant recipients is usually successful, but drainage is often prolonged and may require multiple catheter placements.

© RSNA, 2003

Index terms: Lung, transplantation • Pleura, fluid, 66.761 • Pleura, infection, 66.20 • Pleura, interventional procedures, 66.12986

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