Postoperative Pleural Effusions After Orthotopic Heart Transplant: Cause, Clinical Manifestations, and Course

• Published in: Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation Vol. 14; no. Suppl 3; pp. 125 - 129
• Main Authors: Ulubay, Gaye, Küpeli, Elif, Er Dedekargınoğlu, Balam, Savaş Bozbaş, Şerife, Alekberov, Mahal, Salman Sever, Özlem, Sezgin, Atilla
• Format: Journal Article
• Language: English
• Published: Turkey 01.11.2016
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Drainage - methods; Female; Heart Failure - diagnosis; Heart Failure - etiology; Heart Failure - surgery; Heart Transplantation - adverse effects; Hospitals, University; Humans; Male; Middle Aged; Pleural Effusion - diagnosis; Pleural Effusion - etiology; Pleural Effusion - microbiology; Pleural Effusion - therapy; Recurrence; Retrospective Studies; Risk Factors; Thoracentesis; Thoracoscopy; Time Factors; Treatment Outcome; Turkey
• ISSN: 2146-8427
• DOI: 10.6002/ect.tondtdtd2016.P55

Postoperative pleural effusions are common in patients who undergo cardiac surgery and orthotopic heart transplant. Postoperative pleural effusions may also occur as postcardiac injury syndrome. Most of these effusions are nonspecific and develop as a harmless complication of the surgical procedure itself and generally have a benign course. Here, we investigated the cause and clinical and laboratory features of postoperative early and late pleural effusions in orthotopic heart transplant patients. We retrospectively reviewed the medical records of 50 patients who underwent orthotopic heart transplant between 2004 and 2015 at Baskent University. Patient demographics and clinical and laboratory data, including cause of heart failure, presence of pleural effusions at chest radiography in the first year after transplant, timing of onset, microbiologic and biochemical analyses of pleural effusions, and treatment strategies were noted. Mean age of patients was 39.22 ± 13.83 years (39 men, 11 women). Reason for heart failure was dilated cardiomyopathy in most patients (76%). Nineteen patients (38%) had postoperative pleural effusions, with 15 patients (78.9%) with pleural effusion during the first week after transplant. Of these, 4 patients had recurrent pleural effusion. A diagnostic thoracentesis was performed in 10 patients, with 4 showing transudative effusion and 6 showing exudative effusion secondary to infection (2 patients), postcardiac injury syndrome (1 patient), and hemothorax (3 patients). Aspergillus fumigatus was detected by quantitative culture from pleural effusion in 1 patient. Tube thoracoscopy drainage was performed in 10 patients (25%), and 2 patients received antibiotic therapy. Pleural effusions are frequent after cardiac transplant. Complications may occur in a small portion of patients, with most effusions being nonspecific and having a benign course with spontaneous resolution. Early diagnostic thoracentesis could improve postoperative outcomes in these patients.