Early risk factors of acute lung injury following orthotopic liver transplantation

Abstract

To analyze the early risk factors of acute lung injury (ALI) following orthotopic liver transplantation (OLT). Ninety-one patients with end-stage liver disease, 79 males and 12 females, underwent OLT. The general condition, serum total bilirubin, albumin, creatinine, and prothrombin activity, Child-Turcotte-Pugh (CTP) score, and model for end-stage liver disease (MELD) score 48 h before operation were recorded. The operation time, cold ischemia time of donor's liver, time of anhepatic phase, ascitic fluid, blood loss, RBC infusion amount, crystal infusion, and total infusion during operation were recorded too. Follow-up was conducted for 14 days to observe the clinical manifestation, and time of ventilatory support, arterial blood gas analysis and radiological examination of chest were performed. Univariate analysis and logistic stepwise regression analysis were done to investigate the early risk factors of ALI. 53 patients (58.2%) suffered from pulmonary complications following OLT, including ALI (27.5%) and adult respiratory distress syndrome (ARDS) (5.5%). Univariate analysis showed that preoperative senior age, severe hepatitis B, high serum total bilirubin, low prothrombin activity, and high CTP and MELD scores, and large amount of blood loss and RBC infusion during operation were all risk factors of ALI following OLT (all P < 0.05). Logistic stepwise regression analysis screened out serum total bilirubin as an independent predictor for ALI following OLT. A little more than a quarter of the patients undergoing OLT develop ALI after operation. High preoperative serum total bilirubin is an important early risk factor for ALI following OLT.