Patel, Bhavesh H. and Melamed, Kathryn H. and Wilhalme, Holly and Day, Gwenyth L. and Wang, Tisha and DiNorcia, Joseph and Farmer, Douglas and Agopian, Vatche and Kaldas, Fady and Barjaktarevic, Igor (2023) Implications of Pleural Fluid Composition in Persistent Pleural Effusion following Orthotopic Liver Transplant. Medical Sciences, 11 (1). p. 24. ISSN 2076-3271
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Abstract
Persistent pleural effusions (PPEf) represent a known complication of orthotopic liver transplant (OLT). However, their clinical relevance is not well described. We evaluated the clinical, biochemical, and cellular characteristics of post-OLT PPEf and assessed their relationship with longitudinal outcomes. We performed a retrospective cohort study of OLT recipients between 2006 and 2015. Included patients had post-OLT PPEf, defined by effusion persisting >30 days after OLT and available pleural fluid analysis. PPEf were classified as transudates or exudates (ExudLight) by Light’s criteria. Exudates were subclassified as those with elevated lactate dehydrogenase (ExudLDH) or elevated protein (ExudProt). Cellular composition was classified as neutrophil- or lymphocyte-predominant. Of 1602 OLT patients, 124 (7.7%) had PPEf, of which 90.2% were ExudLight. Compared to all OLT recipients, PPEf patients had lower two-year survival (HR 1.63; p = 0.002). Among PPEf patients, one-year mortality was associated with pleural fluid RBC count (p = 0.03). While ExudLight and ExudProt showed no association with outcomes, ExudLDH were associated with increased ventilator dependence (p = 0.03) and postoperative length of stay (p = 0.03). Neutrophil-predominant effusions were associated with increased postoperative ventilator dependence (p = 0.03), vasopressor dependence (p = 0.02), and surgical pleural intervention (p = 0.02). In summary, post-OLT PPEf were associated with increased mortality. Ninety percent of these effusions were exudates by Light’s criteria. Defining exudates using LDH only and incorporating cellular analysis, including neutrophils and RBCs, was useful in predicting morbidity.
Item Type: | Article |
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Subjects: | Euro Archives > Medical Science |
Depositing User: | Managing Editor |
Date Deposited: | 10 Oct 2023 05:07 |
Last Modified: | 10 Oct 2023 05:07 |
URI: | http://publish7promo.com/id/eprint/3319 |