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Updated: Aug 9, 2026
Local Anesthetic Thoracoscopy for Undiagnosed Pleural Effusion
Published on: November 10, 2023
Intervention for pleural effusions and ascites following liver transplantation
1Radiology Department, Birmingham Children's Hospital NHS Trust, Ladywood Middleway, Birmingham B16 8ET, UK.
Insights
Post-liver transplant fluid collections in children, such as pleural effusions and ascites, often lack a clear cause but can be managed effectively. Ultrasound is recommended for diagnosis and follow-up to minimize radiation exposure.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Radiology
Background:
- Post-liver transplant fluid collections in the pleural and peritoneal cavities are common in children.
- Larger collections may necessitate intervention like aspiration or drainage.
Purpose of the Study:
- To determine the incidence of moderate to large pleural and peritoneal fluid collections after pediatric liver transplantation.
- To assess the need for intervention and treatment outcomes.
- To recommend a management protocol for these post-operative fluid collections.
Main Methods:
- Retrospective review of 184 consecutive liver grafts in 164 children.
- Analysis of fluid collection incidence, diagnosis, and intervention methods.
Main Results:
- 31 (16.8%) grafts developed fluid collections requiring intervention (19 pleural effusions, 8 ascites).
- Diagnosis occurred between days 1-44 post-transplant; initial diagnosis was primarily radiological.
- No significant difference in treatment outcomes was observed between unguided, radiological, and surgical interventions, except when surgery was indicated.
Conclusions:
- Intervention-requiring post-transplant effusions and ascites are often idiopathic.
- Reduced grafts may be associated but don't fully explain occurrence or duration.
- Ultrasound is valuable for diagnosis and follow-up, suggesting its increased use over radiographs to reduce radiation.
Background:
Small volumes of fluid in the pleural and peritoneal cavities are common after paediatric liver transplantation. Occasionally, larger 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 paediatric liver transplantation, the need for intervention and the outcome following radiological and non-radiological treatment, with the ultimate objective of recommending a treatment protocol for such post-operative fluid collections.
Materials And Methods:
A total of 184 consecutive liver 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 effusions were first diagnosed between days 1 and 44 after transplant and the ascites between days 1 and 14. The initial diagnosis was made radiologically in 21 (91%) of 23 pleural effusions and in 10 (83%) of 12 ascites. No identifiable cause or association was seen in 18 (58%) of 31 cases. The mean duration of the pleural effusions and ascites, from onset of treatment to resolution, ranged from 33 +/- 42 days (SD) to 35 +/- 48 days and from 36 +/- 47 days to 39 +/- 46 days respectively. Comparison of the modes of interventional treatment (i.e. unguided, radiological and surgical) showed no statistically significant difference in the outcome of the management.
Conclusions:
Post-transplantation pleural effusions and ascites requiring intervention are often without definite cause. They are more common with reduced grafts, but this cannot completely explain the occurrence or the protracted duration of accumulation in spite of combined interventional management. The outcome of treatment is not significantly influenced by the mode of intervention except in cases where surgical intervention is indicated. Patients could be managed effectively without resorting to chronic outpatient aspiration. US contributed significantly in the initial and follow-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.
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