Tunneled Pleural Catheter to Manage Recurrent Post-Transplant Effusion

Abstract

Introduction Pleural effusions after lung transplant (LT) are common and use of chest tubes is routine. Chronic pleural effusion post-LT, can impede attainment of best pulmonary function. Therapeutic interventions may include tube thoracostomy, pleural decortication, and pleurodesis. Due to concerns related to immunosuppression and fears of infection, tunneled pleural catheters (TPC) are not typically considered post-LT. Case Report A 71-year-old female with IPF underwent an uncomplicated right LT and chest tubes were weaned in the usual fashion. As an outpatient, pulmonary function and physical recovery were below expectations and imaging demonstrated pleural effusion. Given multiple recurrences despite tube thoracostomy and impaired physical recovery, a TPC was considered. Following sterile TPC placement, the patient was able to drain her effusion at home, while increasing participation in rehabilitation, ultimately achieving functional independence. The catheter was removed when pleural output was minimal and spontaneous pleurodesis was assumed. The patient suffered no infectious complications and at one-year, pleural effusion has not recurred. Summary Prolonged or recurrent pleural effusions following LT may cause dyspnea and impede functional recovery. While TPCs are typically used to control malignant or benign effusions, they can provide several advantages in the LT population. Tunneling reduces infectious risk, low profile avoids accidental dislodgement, and they can be placed and managed as an outpatient, avoiding setbacks associated with a surgical procedure. With malignant pleural effusions, these catheters relieve symptoms and by 6 weeks, 45% may achieve spontaneous pleurodesis. Though shown to be safe in a case series of LT recipients, these catheters are rarely used post-LT. Infection is a feared complication, though occurs in only 5% of patients, with empyema seen in about 3% of cases. In appropriately selected patients, TPCs may be a viable alternative to manage recurrent pleural effusions.