Pulmonary complications of liver transplantation: radiological appearance and statistical evaluation of risk factors in 300 cases

Abstract

The aim of this study was to evaluate the incidence, radiographic appearance, time of onset, outcome and risk factors of non-infectious and infectious pulmonary complications following liver transplantation. Chest X-ray features of 300 consecutive patients who had undergone 333 liver transplants over an 11-year period were analysed: the type of pulmonary complication, the infecting pathogens and the mean time of their occurrence are described. The main risk factors for lung infections were quantified through univariate and multivariate statistical analysis. Non-infectious pulmonary abnormalities (atelectasis and/or pleural effusion: 86.7%) and pulmonary oedema (44.7%) appeared during the first postoperative week. Infectious pneumonia was observed in 13.7%, with a mortality of 36.6%. Bacterial and viral pneumonia made up the bulk of infections (63.4 and 29.3%, respectively) followed by fungal infiltrates (24.4 %). A fairly good correlation between radiological chest X-ray pattern, time of onset and the cultured microorganisms has been observed in all cases. In multivariate analysis, persistent non-infectious abnormalities and pulmonary oedema were identified as the major independent predictors of posttransplant pneumonia, followed by prolonged assisted mechanical ventilation and traditional caval anastomosis. A "pneumonia-risk score" was calculated: low-risk score ( < 2.25) predicts 2.7% of probability of the onset of infections compared with 28.7% of high-risk (> 3.30) population. The "pneumonia-risk score" identifies a specific group of patients in whom closer radiographic monitoring is recommended. In addition, a highly significant correlation (p < 0.001) was observed between pneumonia-risk score and the expected survival, thus confirming pulmonary infections as a major cause of death in OLT recipients.

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

“…Interestingly, previous studies have reported rates varying from 36.6% to 53%. 4,7,11 This suggests an overall improvement in the management of severe sepsis or septic shock in liver recipients over time, and this might have contributed to the improvement over time of postoperative survival after LT. 14 Similarly, we reported a low long-term mortality rate (21.7%) apparently lower than the previously reported rates (usually approximately 50%). 5,6 We did not find significant excessive mortality in E-HAP patients.…”

“…[25][26][27][28][29] Our rate of 15.5% among liver recipients agrees with previously reported rates of pneumonia after LT ranging from 5% to 34%. [4][5][6][7][8][9][10]30 Two recent studies showed a rate of pneumonia of 21.1% in liver recipients receiving a 3-day prophylactic regimen of CTX and ampicillin and a rate of 18% in living donor-related recipients receiving selective digestive decontamination. 6,9 Routine, prolonged prophylactic antibiotic treatment and selective digestive decontamination were not administered in our population.…”

“…[2][3][4] The incidence of these infections has been shown to vary from 5% to 48%, whereas estimates of the related mortality rate range from 36.6% to 53%. [4][5][6][7][8][9][10][11] Hospital-acquired pneumonia (HAP) and ventilatorassociated pneumonia are commonly dichotomized according to the delay of occurrence: early-onset hospital-acquired pneumonia (E-HAP) and early-onset ventilator-associated pneumonia are usually defined as occurring within the first 4 or 6 days of hospitalization, whereas late-onset hospital-acquired pneumonia (L-HAP) and late-onset ventilator-associated pneumonia occur after this timepoint. 12,13 The types of causative pathogens and their susceptibility differ between these 2 categories, and specific empirical antimicrobial therapy guidelines have been implemented according to these distinctions.…”

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“…Routine postoperative laboratory investigations and chest radiographic scans were done for all patients immediately after transplant and then daily throughout ICU stay. In accordance with Golfieri and associates, 11 atelectasis was radiologically classified into 3 grades. Grade 1 atelectasis referred to involvement of 1 subsegment or discoid atelectasis, grade 2 atelectasis represented 2 subsegments affected, and grade 3 represented ≥ 3 subsegments affected.…”

Critical Care Management after Adult Liver Transplantation

“…İntraoperatif risk faktörleri olarak cerrahi girişim (geniş insizyon, mekanik travma, uzun cerrahi ve/veya greft iskemi süresi), aşırı sıvı ve kan transfüzyonu, pozitif sıvı dengesi, ağır reperfüzyon sendromu gösterilmiştir. Postoperatif risk faktörleri olarak da greft akut rejeksiyonu veya PNF, ağır immün yetersizlik, akut böbrek yetersizliği, sağ diyafragma paralizisi, hemodinamik instabilite, cerrahi komplikasyonlar ve reoperasyon bildirilmiştir (79)(80)(81)(82)(83)(84).…”