Early respiratory complications after liver transplantation

Abstract

The poor clinical conditions associated with end-stage cirrhosis, pre-existing pulmonary abnormalities, and high comorbidity rates in patients with high Model for End-Stage Liver Disease scores are all well-recognized factors that increase the risk of pulmonary complications after orthotopic liver transplantation (OLT) surgery. Many intraoperative and postoperative events, such as fluid overload, massive transfusion of blood products, hemodynamic instability, unexpected coagulation abnormalities, renal dysfunction, and serious adverse effects of reperfusion syndrome, are other factors that predispose an individual to postoperative respiratory disorders. Despite advances in surgical techniques and anesthesiological management, the lung may still suffer throughout the perioperative period from various types of injury and ventilatory impairment, with different clinical outcomes. Pulmonary complications after OLT can be classified as infectious or non-infectious. Pleural effusion, atelectasis, pulmonary edema, respiratory distress syndrome, and pneumonia may contribute considerably to early morbidity and mortality in liver transplant patients. It is of paramount importance to accurately identify lung disorders because infectious pulmonary complications warrant speedy and aggressive treatment to prevent diffuse lung injury and the risk of evolution into multisystem organ failure. This review discusses the most common perioperative factors that predispose an individual to postoperative pulmonary complications and these complications' early clinical manifestations after OLT and influence on patient outcome.

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“…Thus, liver transplant recipients are liable to considerable risks of morbidity and mortality from surgery com plications (intra-or postoperative hemorrhage, vascular or biliary complications), graft dysfunction or rejection, and infections, especially during the first month after liver transplant, which is considered to be the most critical period. 11,17,18 Although post transplant pneumonia occurs less frequently than other infections, such as intra-abdominal, biliary tract, and urinary tract infections, they can cause more morbidity and mortality due to rapid progression to diffuse lung injury and multisystem organ failure. 18,19 In this study, we followed patients who received LDLT at the Gastroenterology Center, Mansoura University, Egypt, to monitor and evaluate all pulmonary infectious complications that may affect those patients within the first month after transplant.…”

“…11,17,18 Although post transplant pneumonia occurs less frequently than other infections, such as intra-abdominal, biliary tract, and urinary tract infections, they can cause more morbidity and mortality due to rapid progression to diffuse lung injury and multisystem organ failure. 18,19 In this study, we followed patients who received LDLT at the Gastroenterology Center, Mansoura University, Egypt, to monitor and evaluate all pulmonary infectious complications that may affect those patients within the first month after transplant. Our aim was to identify an effective management strategy.…”

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).…”

“…Böyle bir durumda ventilasyonu rahatlatacak kadar asit drenajı (parasentez) uygulanır. Parasentez uygulanan hastalarda sıvı/albumin replasmanı yapılmalı, idrar çıkışı ile böbrek fonksiyon testleri izlenmeli ve hemodinamik dengeye dikkat edilmelidir (40,83,102).…”

“…Postoperatif pulmoner komplikasyonların azaltılmasında erken ekstübasyon, ekstübasyon sonrası solunum fizyoterapisi ve erken mobilizasyon, NİV uygulaması, yeterli postoperatif ağrı tedavisi, hipervoleminin önlenmesi, bronşiyal sekresyonların etkin temizlenmesi ve enfeksiyonların önlenmesi önemli yer tutar (12,83,84,91,103).…”