Va. Adetiloye et Pr. John, INTERVENTION FOR PLEURAL EFFUSIONS AND ASCITES FOLLOWING LIVER-TRANSPLANTATION, Pediatric radiology, 28(7), 1998, pp. 539-543
Citations number
7
Categorie Soggetti
Radiology,Nuclear Medicine & Medical Imaging",Pediatrics
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.