Abstract
ObjectivePost-operative pulmonary complications significantly affect patient survival rates, but there is still no conclusive evidence regarding the effect of post-operative respiratory failure after liver transplantation on patient prognosis. This study aimed to predict the risk factors for post-operative respiratory failure (PRF) after liver transplantation and the impact on short-term survival rates.DesignThe retrospective observational cohort study was conducted in a twelve-bed adult surgical intensive care unit in northern Taiwan. The medical records of 147 liver transplant patients were reviewed from September 2002 to July 2007. Sixty-two experienced post-operative respiratory failure while the remaining 85 patients did not.Measurements and Main ResultsGender, age, etiology, disease history, pre-operative ventilator use, molecular adsorbent re-circulating system (MARS) use, source of organ transplantation, model for end-stage liver disease score (MELD) and Child-Turcotte-Pugh score calculated immediately before surgery were assessed for the two groups. The length of the intensive care unit stay, admission duration, and mortality within 30 days, 3 months, and 1 year were also evaluated. Using a logistic regression model, post-operative respiratory failure correlated with diabetes mellitus prior to liver transplantation, pre-operative impaired renal function, pre-operative ventilator use, pre-operative MARS use and deceased donor source of organ transplantation (p<0.05). Once liver transplant patients developed PRF, their length of ICU stay and admission duration were prolonged, significantly increasing their mortality and morbidity (p<0.001).ConclusionsThe predictive pre-operative risk factors significantly influenced the occurrence of post-operative respiratory failure after liver transplantation.
Highlights
Liver transplantation (LT) is currently the only definite treatment for acute liver failure and chronic end-stage liver diseases
The predictive pre-operative risk factors significantly influenced the occurrence of post-operative respiratory failure after liver transplantation
According to the Taiwan Organ Registry and Sharing Center, the model for end-stage liver disease (MELD) score is divided into three categories, 10–18, 19–24, and $ 25, which accounted for 35.4%, 28.6%, and 36.1% of the patients, respectively
Summary
Liver transplantation (LT) is currently the only definite treatment for acute liver failure and chronic end-stage liver diseases. Because of a shortage of liver donations, patients may have to wait for a long time for a liver transplantation. When liver transplantations are performed, the patients are already very sick. These patients may have a high incidence of common respiratory disorders including atelectasis, pleural effusion and poor compliance of the respiratory system due to edema of the chest wall or high intra-abdominal pressure. All of these respiratory disorders can affect the function of alveolar gas exchange. Some patients may even need intubation and ventilation
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