Intervention for pleural effusions and ascites following liver transplantation.

BACKGROUND

Small volumes of fluid in the pleural and peritoneal cavities are common after paediatric liver transplantation. Occasionally, larger fluid collections develop and need intervention by aspiration or insertion of a drain. Objective. To assess the incidence of moderate and large pleural and peritoneal fluid collections following paediatric liver transplantation, the need for intervention and the outcome following radiological and non-radiological treatment, with the ultimate objective of recommending a treatment protocol for such post-operative fluid collections.

MATERIALS AND METHODS

A total of 184 consecutive liver grafts in 164 children were reviewed.

RESULTS

Of 184 grafts, 31 (16.8%) developed excessive fluid collections requiring intervention (19 pleural effusions, 8 ascites and 4 effusions and ascites). The effusions were first diagnosed between days 1 and 44 after transplant and the ascites between days 1 and 14. The initial diagnosis was made radiologically in 21 (91%) of 23 pleural effusions and in 10 (83%) of 12 ascites. No identifiable cause or association was seen in 18 (58%) of 31 cases. The mean duration of the pleural effusions and ascites, from onset of treatment to resolution, ranged from 33 +/- 42 days (SD) to 35 +/- 48 days and from 36 +/- 47 days to 39 +/- 46 days respectively. Comparison of the modes of interventional treatment (i.e. unguided, radiological and surgical) showed no statistically significant difference in the outcome of the management.

CONCLUSIONS

Post-transplantation pleural effusions and ascites requiring intervention are often without definite cause. They are more common with reduced grafts, but this cannot completely explain the occurrence or the protracted duration of accumulation in spite of combined interventional management. The outcome of treatment is not significantly influenced by the mode of intervention except in cases where surgical intervention is indicated. Patients could be managed effectively without resorting to chronic outpatient aspiration. US contributed significantly in the initial and follow-up evaluation of these patients, even in cases of pleural effusions, and we would recommend greater use of US in place of radiographs to reduce the radiation burden when fluid collections are protracted.