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The pleural space and organ transplantation
1Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, USA.
Summary
Pleural disease is common before and after organ transplantation, impacting patients undergoing heart, liver, and kidney transplants. Management varies, with lung transplant candidates needing minimal pleurodesis to avoid complications.
Area of Science:
- Pulmonology
- Transplant Surgery
- Immunology
Background:
- Pleural disease presents significant challenges in organ transplant candidates and recipients.
- Pleural effusions are frequently observed in patients awaiting heart, liver, and kidney transplants.
Purpose of the Study:
- To review the implications of pleural disease in organ transplantation.
- To discuss pre- and post-transplant pleural complications and their management.
Main Methods:
- Literature review of pleural disease in organ transplantation.
- Analysis of organ-specific and non-organ-specific pleural complications.
- Discussion of treatment strategies, particularly for lung transplant candidates.
Main Results:
- Pleural effusions are common pre-transplant; thoracentesis is indicated if not due to organ failure.
- Post-transplant pleural infections and PTLD are linked to immunosuppression.
- Organ-specific complications include hepatic venoocclusive disease, GVHD-related pneumothorax, and kidney transplant-related effusions (urinothorax, lymphocele).
Conclusions:
- Pleural effusions post-lung transplantation may indicate acute rejection.
- Minimizing pleurodesis is crucial for lung transplant candidates.
- Interpleural communication after certain lung/heart-lung transplants has therapeutic relevance.