title: Safety of peritoneal and pleural drain placement in pediatric stem cell transplant recipients with severe veno-occlusive disease.
abstract: Hepatic VOD (veno-occlusive disease) is a serious complication of HSCT (hematopoietic stem cell transplantation) and has historically been associated with high mortality. This obstruction to hepatic flow often results in fluid collections in the peritoneal and pleural cavities. Catheter placement to drain ascites or pleural fluid may reduce intra-abdominal hypertension and/or improve respiratory parameters. The safety of these interventions among critically ill, immunocompromised children is unknown. Among 32 HSCT recipients (2000-2012) with severe VOD, we assessed the primary outcome of procedural complication from peritoneal drain placement. Twenty-four (75%) patients underwent peritoneal drain placement. No patient sustained visceral perforation or hemorrhage with drain placement. Overall mortality was 47% (n = 15). The procedure was not associated with increased overall mortality (p > 0.99). Eight (25%) peritoneal drains required replacement for malfunction. Of 24 patients with peritoneal drains, one (4%) patient had a positive culture from ascitic fluid. Eight (25%) patients underwent pleural drain placement. No pleural drain-related procedural complication or infection occurred. Four (50%) of the eight patients with pleural drains had de-escalation in oxygen requirement at drain removal, compared to time of placement. In this study, peritoneal and pleural drains were safe interventions for children with severe VOD.
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.|Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Arin L
authors.identifier: 0000-0003-1258-7278
authors.initials: AL
authors.lastname: Madenci
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Stetson
authors.affiliation: Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.|Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Weldon
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.|Division of Hematology/Oncology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Leslie E
authors.initials: LE
authors.lastname: Lehmann
mesh_terms: D001201:Ascites / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D010996:Pleural Effusion / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: hematopoietic stem cell transplantation; pediatric; peritoneal drain; pleural drain; sinusoidal obstruction syndrome; veno-occlusive disease