Pleural Effusions Requiring Thoracocentesis Are Associated With Baseline Lung Allograft Dysfunction and Mortality in Lung Transplant Recipients

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BACKGROUND: Pleural effusions of unknown etiology have been demonstrated to be associated with poor prognosis in lung allograft recipients. We aimed to identify novel risk factors for pleural effusions after lung transplantation (LTX) and to shed light on their association with allograft function and survival, differentiating early and late pleural effusions after LTX. METHODS: We performed a retrospective study of all LTX recipients transplanted at the LMU Klinikum Munich from 2013 to 2018. We recorded all pleural effusions requiring thoracocentesis and analyzed the corresponding clinical data. A total of 426 pleural effusions in 369 lung allograft recipients with a median follow-up time of 6.9 years were analyzed. RESULTS: Both early (<90 days after LTX) and late pleural effusions (>90 days after LTX) were associated with increased mortality, with a strong mortality risk for late pleural effusions (HR 4.0). Increased mortality in patients with early pleural effusions might be mediated by a higher risk for baseline lung allograft dysfunction (BLAD). Early pleural effusions were associated with underlying obstructive disease, relative donor organ undersizing and clamshell thoracotomy. Notably, (partial) resection of the parietal pleura during LTX was not associated with pleural effusions. CONCLUSIONS: This study underlines the importance of pleural effusions after LTX. All pleural effusions were associated with increased mortality, while only early pleural effusions were associated with BLAD. The mechanisms linking pleural effusions to BLAD and to higher mortality remain unknown and will be investigated in future, prospective cohorts.

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