LAUSR

Learning Objectives: Patients who undergo liver transplantation (LT) were reported to have pleural effusions or hepatic hydrothorax that were diagnosed by routine chest radiograph (CXR) during preoperative evaluation. Previous studies in pre-LT patients used CXR to detect pleural effusions. Currently, pointof-care lung ultrasound (PCLUS) is a fast, widely available and non-invasive modality that can detect pleural effusions in the perioperative period. To ourknowledge, there is no published report evaluating the immediate pre-LT assement by PCLUS for pleural effusions. The aims of our study were to assess the prevalence of pleural effusions diagnosed by PCLUS in patients immediately prior to LT and to determine the outcomes post-LT related to the presence of a pleural effusion. Methods: We prospectively recruited patients who were undergoing LT in the immediate pre-op window, and performed bedside PCLUS. Lung ultrasound was uniformly performed by protocol, and the presence of pleural effusion was compared with routine CXR that was done on the same day. Outcome variables were length of hospital stay, length of ICU stay, and postoperative respiratory complications. Results: Of 132 patients included in the study, 79 patients had a pre-op pleural effusion (PLEff group), and 55 patient did not have pleural effusion by PCLUS examination. Age, gender, etiology of liver cirrhosis, SOFA and SAPS II score were similar between both groups; model for end-stage liver disease score was significantly higher in the PLEff group. Pleural effusions were diagnosed in 10 (42%) patients by PCLUS who had a negative CXR. Composite post-op pulmonary complication rate (relative risk, RR, 1.17, p=0.002) and requirement for post-op thoracentesis (RR 3, p=0.008) were significantly higher in PLEff group. ICU and hospital length of stay after transplant (RR 0.53, p=0.63 and RR 1.42, p= 0.07) were similar between the two groups. Conclusions: The detection of pleural effusion by immediate preop PCLUS was feasible and had a higher higher sensitivity than CXR. Furthermore, patients who presented with pleural effusion had higher postoperative pulmonary complication rates without an impact on their overall length of ICU or hospital stay.