Peritoneal and Pleural Drains in Pediatric Hematopoietic Cell Transplant Recipients with Veno-Occlusive Disease are Safe and Do Not Adversely Impact Clinical Outcomes

There is a lack of data on the safety and efficacy of peritoneal drain (PD) and chest tube (CT) in the management of effusions in stem cell transplant recipients with veno-occlusive disease (VOD). In this retrospective pediatric study, clinical outcomes and health resource utilization (HRU) were compared in 32 patients with VOD who had a PD (PDþ) post-HCT versus 27 patients who did not (PD-). Nine patients also had a CT (7 PDþ and 2 PD-). PD þ patients were more likely than PD-patients to have received myeloablative conditioning (100% vs. 85.2%; p ¼ 0.04) and have severe or very severe VOD (100% vs. 56% p < 0.01). Mechanical obstruction (38%) and hypotension (38%) were common complications, and 13% developed peritonitis. While the frequencies of cardiac dysfunction and acute kidney injury were comparable between both groups, respiratory support and its median duration were higher in PD þ patients. The hospital and intensive care unit length of stay, albumin use, and the duration of defibrotide and albumin therapy was significantly longer in PD þ patients. At a median follow-up of 1.04 years (range:0.03e14.6), the 2-year overall survival was similar in both groups (53.8% vs. 51.5%; p ¼ 0.73). Although PD use was similar between 1995 and 2007 vs. 2008e2021; (47% vs. 58%; p ¼ 0.65), dayþ100 mortality was improved in recent years (53.3% vs. 17.8%; p ¼ 0.01), coinciding with the use of defibrotide (0% vs. 84%; p < 0.01). PD in pediatric patients with VOD post-HCT, although associated with increased HRU, was safe when clinically indicated and did not adversely impact clinical outcomes.