Importance of radiological detection of early pulmonary acute complications of liver transplantation: analysis of 259 cases.

Abstract

Pulmonary complications are common causes of morbidity and mortality after orthotopic liver transplantation (OLT) and consist of atelectasis, pleural effusion, pulmonary oedema, adult respiratory distress syndrome (ARDS) and pneumonia. The aim of this paper is to describe the incidence of pulmonary complications after OLT during the first postoperative week and to evaluate the informative value of the chest X-ray (CXR) in clinical practice. Patients who underwent OLT at the Ancona Transplant Centre between August 2005 and August 2012 were included in this retrospective study. The CXR and, if performed, the thoracic computed tomography (TCT) scans performed during the first 7 postoperative days were reviewed, and the radiological findings for atelectasis, pleural effusion, pulmonary oedema, ARDS and pneumonia were independently assessed and quantified by two radiologists according to the Fleischner Society criteria. Cases of pneumothorax after thoracentesis were assessed. Development of pneumonia was defined as the simultaneous presence of positive CXR or TCT and positive serological or fluid samples and clinical symptoms; the prevalence of infectious agents was assessed. The radiological reports produced in the clinical setting were compared with the findings. Among 259 patients included, atelectasis was observed in 227 patients (87.6%); pleural effusion in 250 (96.5%); pulmonary oedema in 204 (78%); ARDS in seven patients (2.6%); and pneumothorax in 37 patients (14%). Pneumonia occurred in 32 cases (12.3%). Pulmonary oedema was underestimated in the radiological reports in 104 cases (40%). Knowledge about postoperative pulmonary complications and collaboration between the radiologist and clinician are essential for improving the management of OLT recipients.