title: Tunneled Indwelling Pleural Catheters for Refractory Pleural Effusions after Solid Organ Transplant. A Case-Control Study.
abstract: The use of tunneled indwelling pleural catheters for management of refractory pleural effusions continues to increase. Pleural space infections are among the most common and serious complication of the procedure. The risk may be higher in patients receiving immunosuppressive medications.
  
  
  
  The aim of this study was to assess the risk of infections complicating placement of a tunneled indwelling pleural catheter in patients who have received a solid organ transplant.
  
  
  
  Electronic medical records were retrospectively reviewed to identify patients with prior solid organ transplant who subsequently underwent placement of a tunneled intrapleural catheter. We selected a matched sample of comparison patients without solid organ transplant who underwent the same procedure during the study period. Detailed chart abstraction was performed to compare baseline clinical information with procedure outcomes in both groups.
  
  
  
  Nineteen study patients underwent kidney, liver, lung, or heart transplant. Another 55 patients were included in the nontransplant comparison group. Transplant patients were taking a mean of 2.4 (range, 1-4) immunosuppressive medications. In transplant patients, the intrapleural catheter remained in place for a median of 95 days (interquartile range, 58-256 d). Two of the 19 transplant patients (16.9% 90-day Kaplan-Meier estimate) and 4 of the 55 control patients (11.0% weighted 90-day Kaplan-Meier estimate) developed a major infectious complication (not significant). There were no deaths attributed to intrapleural catheter placement in either group.
  
  
  
  In a series of 19 patients with solid organ transplantation taking daily immunosuppressive medications who underwent placement of a tunneled intrapleural catheter, we report an 11% rate of major infectious complications over the lifetime of the catheter in the transplant group with no significant difference in 90-day estimated risk of complication between transplant and nontransplant comparison group.
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota; and.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Skalski
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota; and.
authors.forename: Jasleen
authors.initials: J
authors.lastname: Pannu
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota; and.
authors.forename: Humberto C
authors.initials: HC
authors.lastname: Sasieta
authors.affiliation: 1 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota; and.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Edell
authors.affiliation: 2 Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: Fabien
authors.initials: F
authors.lastname: Maldonado
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002408:Catheters, Indwelling / Q000009:adverse effects*; D004322:Drainage / Q000379:methods; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D016377:Organ Transplantation / Q000009:adverse effects*; D010996:Pleural Effusion / Q000453:epidemiology* / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors
keywords: PleurX; immunosuppression; pleural effusion; transplant; tunneled indwelling pleural catheter