PLEURAL EFFUSIONS FOLLOWING LUNG TRANSPLANTATION - TIME-COURSE, CHARACTERISTICS, AND CLINICAL IMPLICATIONS

The time course and characteristics of ipsilateral pleural effusion in nine consecutive single lung transplant recipients are described and compared with those of six patients who underwent other cardiothoracic operations, Ipsilateral pleural fluid occurs in all lung transplant r ecipients, beginning immediately following transplantation and continu ing for up to 9 days. Pleural fluid immediately after lung transplanta tion is bloody, exudative, and neutrophil predominant, which is simila r to the characteristics of pleural fluid following other cardiothorac ic surgery, Pleural fluid cellularity, lactate dehydrogenase, and tota l protein content decrease rapidly over the first week in lung transpl ant recipients. The percentage of neutrophils decreases from 90 to 50% by day 7. Pleural fluid output in lung transplant recipients declines steadily during the first week and is minimal by day 9. Pleural fluid output declines more rapidly in patients who have undergone cardiotho racic surgery than in the lung transplant recipients. An early rise in pleural fluid output may reflect the development of posttransplant pu lmonary edema, We conclude that it is unnecessary to analyze pleural f luid after lung transplantation if the pleural fluid output is decreas ing and the clinical course is appropriate.