Tunneled Indwelling Pleural Catheters (TIPC) for Refractory Pleural Effusions in Patients With Solid Organ Transplant

Abstract

SESSION TITLE: Interventional Pulmonary SESSION TYPE: Original Investigation Slide PRESENTED ON: Sunday, October 25, 2015 at 04:30 PM - 05:30 PM PURPOSE: The use of tunneled indwelling pleural catheters (TIPC) for symptomatic management of refractory pleural effusions continues to rise. Pleural space infections occur in 5% of patients with TIPC for malignant pleural effusions, and this risk is likely higher in patients receiving immunosuppressive therapy which is often considered a relative contraindication to TIPC placement. The use of TIPCs for refractory pleural effusions in solid organ transplant recipients, a population typically maintained on high levels of immunosuppression, has not been reported. METHODS: Electronic records were retrospectively reviewed to identify all patients at our institution with solid organ transplant who subsequently underwent TIPC placement between 1/1/2005 and 12/31/2014. In each patient meeting inclusion criteria, a detailed chart abstraction was performed to identify indication for catheter placement, duration of TIPC, immunosuppressive medication regimen, and TIPC related complications including infection or death. RESULTS: A total of 19 patients were identified, with the following solid organ transplants: kidney (n=12), liver (n=4), heart (n=4), and lung (n=1) with some patients having several organ transplants. TIPC was placed for malignant pleural effusion in 26% (5/19) with the remainder placed for non-malignant indications such as congestive heart failure or hepatic hydrothorax. Patients were taking a mean of 2.4 different immunosuppressive agents at the time of their TIPC placement, and the two most commonly used agents were tacrolimus (n=13) and mycophenolate (n=13). The TIPC remained in place for a median of 95 days (interquartile range 58-241 days). The most common reasons for removal were patient death (n=9) and autopleurodesis (n=8). Two out of the 19 patients developed pleural space infection; both requiring hospitalization. In both cases, the patients were successfully treated with IV and oral antibiotics and did not require thoracic surgical intervention or removal of the TIPC. There were no deaths due to TIPC complication. CONCLUSIONS: In this series of patients with solid organ transplantation who underwent TIPC implantation, we report an 11% rate of major infectious complication with no fatal complications. CLINICAL IMPLICATIONS: Placement of TIPC may be an option for patients with prior solid organ transplant who develop refractory pleural effusions. The benefit to the patient must be weighed against the risk of infection. DISCLOSURE: The following authors have nothing to disclose: Joseph Skalski, Fabien Maldonado No Product/Research Disclosure Information