Cost Utilization and the Use of Pulmonary Function Tests in Preoperative Liver Transplant Patients

Abstract

Background Pulmonary function tests (PFTs) are currently recommended for liver transplant candidates. We hypothesized that PFTs may not provide added clinical value to the evaluation of liver transplant patients. Methods We conducted a retrospective cohort study of adult cadaveric liver transplants from 2012 to 2018. Abnormal PFTs were defined as restrictive disease of diffusing capacity of the lungs for carbon monoxide (DLCO) <80% or obstructive disease of ratio of forced expiratory volume in the first 1 second to the first vital capacity of the lungs (FEV1/FVC) <70%. Results We analyzed data on 415 liver transplant patients (358 abnormal PFT results and 57 normal results). The liver transplant patients with abnormal PFTs had no difference in number of intensive care unit (ICU) days ( P = .68), length of stay ( P = .24), or intubation days ( P = .33). There were no differences in pulmonary complications including pleural effusion ( P = .30), hemo/pneumothorax ( P = .74), pneumonia ( P = .66), acute respiratory distress syndrome ( P = .57), or pulmonary edema ( P = .73). The significant finding between groups was a higher rate of reintubation in liver transplant patients with normal PFTs ( P = .02). There was no difference in graft survival ( P = .53) or patient survival ( P = .42). Discussion Abnormal PFTs, found in 86% of liver transplant patients, did not correlate with complications, graft failure, or mortality. PFTs contribute to the high cost of liver transplants but do not help predict which patients are at risk of postoperative complications.

Pulmonary function testing in patients with liver cirrhosis (Review)

“…As regards the role of PFTs in the prognosis of patients with liver cirrhosis, as it was mentioned above, DLCO, TLC and RV have been described as significant predictors of ventilator time and both ICU and hospital LOS (P<0.05), but not of patients of graft survival undergoing liver transplantation ( 38 ). Moreover, according to another study, although abnormal PFTs are found in a great proportion of patients undergoing liver transplants, they are not associated with complications, graft failure, or mortality following liver transplantation ( 111 ).…”