Postliver Transplantation Pulmonary Complications

Abstract

We read the article by Levesque et al. (1) with great interest. We congratulate the authors for addressing this important issue in the critical care of liver transplant recipients. We have few queries regarding the study. Until date, to our knowledge, this is the first study in cohort of liver transplant recipients using modified clinical pulmonary infection score (CPIS) to diagnose pneumonia. CPIS has been originally devised for diagnosis of ventilator-associated pneumonia (VAP) (2), and the authors did not mention the incidence of VAP. The authors used the modified CPIS score to confirm the diagnosis of pneumonia, which excludes the culture results (3). CPIS is still not validated for the diagnosis of VAP and has low sensitivity, 60%, and specificity, 43%, if it excludes the culture results (4). It would be great to know the sensitivity and specificity of CPIS score in this cohort as compared with quantitative bronchoalveolar lavage culture. In this study, there were 55 episodes of pneumonia; out of that, only 39 are reported to be culture positive. It means that, for 16 times, no microorganism was isolated. The protocol for antibiotics is for 48 hr after transplantation; how many patients were on antibiotics when they were diagnosed to have pneumonia? History of acute cellular rejection is an independent risk factor for developing pneumonia (5). The incidence of rejection in the study population is not mentioned. It will be interesting to know the risk of pneumonia in this subset of patients. In the pulmonary complication group, how many patients were having associated renal dysfunction that required dialysis? It might affect pulmonary complications (5). Did the authors control the ascites and pleural effusion before performing the pulmonary function test because it might improve patient compliance? At one point, it is stated that age is not the risk factor, but is the P value significant? Patients with upper abdominal surgery are expected to have some pleural effusion during the immediate postoperative period; however, in this study, pleural effusion was evaluated on the seventh day after the transplantation on computed tomographic scan as per routine protocol. Are there any other methods (bedside chest x-ray and ultrasound) used to evaluate pleural effusion before 7 days? How many patients experienced early effusion? Shridhar V. Sasturkar 1 Viniyendra Pamecha1 Vijay Kant Pandey2 1 Department of Hepatico-Pancreatic-Biliary Surgery and Liver Transplantation Institute of Liver and Biliary Sciences New Delhi, India 2 Department of Anesthesiology and Intensive Care Institute of Liver and Biliary Sciences New Delhi, India