INTERVENTION FOR PLEURAL EFFUSIONS AND ASCITES FOLLOWING LIVER-TRANSPLANTATION

Background. Small volumes of fluid in the pleural and peritoneal cavit ies are common after paediatric liver transplantation. Occasionally, l arger 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 paediatri c liver transplantation, the need for intervention and the outcome fol lowing radiological and non-radiological treatment, with the ultimate objective of recommending a treatment protocol for such postoperative fluid collections. Materials and methods. A total of 184 consecutive l iver 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 eff usions were first diagnosed between days 1 and 44 after transplant and the ascites between days 1 and 14. The initial diagnosis was made rad iologically in 21 (91 %) of 23 pleural effusions and in 10 (83 %) of 1 2 ascites. No identifiable cause or association was seen in 18 (58 %) of 31 cases. The mean duration of the pleural effusions and ascites, f rom onset of treatment to resolution, ranged from 33 +/- 42 days (SD) to 35 +/- 48 days and from 36 +/- 47 days to 39 +/- 46 days respective ly. Comparison of the modes of interventional treatment (i. e. unguide d, radiological and surgical) showed no statistically significant diff erence in the outcome of the management. Conclusions. Post-transplanta tion pleural effusions and ascites requiring intervention are often wi thout definite cause. They are more common with reduced grafts, but th is cannot completely explain the occurrence or the protracted duration of accumulation in spite of combined interventional management. The o utcome of treatment is not significantly influenced by the mode of int ervention except in cases where surgical intervention is indicated. Pa tients could be managed effectively without resorting to chronic outpa tient aspiration. US contributed significantly in the initial and foll ow-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.