Intensive Care of Pulmonary Complications Following Liver Transplantation

Lui, Justin K.; Spaho, Lidia; Holzwanger, Erik; Bui, Rosa; Daly, Jennifer S.; Bozorgzadeh, Adel; Kopec, Scott

doi:10.1177/0885066618757410

Cited by 19 publications

(22 citation statements)

References 167 publications

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“…Patients with encephalopathy, marked hypoxemia, obesity (BMI > 30), severe hemodynamic instability, pulmonary edema, cardiac or renal dysfunction, and multiple transfusions are not indicated for EE. The personalized and selective approach is likely to be the best strategy with a focus on avoiding delayed extubation, preserving hemodynamic stabilization, and ensuring graft functionality [63].…”

Section: Ventilatory Support and Weaning From Mechanical Ventilationmentioning

confidence: 99%

“…During MV, lungs and liver allograft interaction should be taken into account with the aim of improving oxygenation without impairing the outflow of the liver graft. Implementation of daily withdrawal of sedation combined with spontaneous breathing trial facilitates weaning from MV [63]. Acute respiratory distress syndrome (ARDS), one of the prominent respiratory complications following LT, is usually attributed to reperfusion syndrome, substantial blood loss and transfusions, prolonged operation time, and early postoperative infections and sepsis.…”

Section: Ventilatory Support and Weaning From Mechanical Ventilationmentioning

confidence: 99%

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Management of Patients with Liver Transplantation in ICU

Karapanagiotou¹,

Pitsoulis²,

Vasileiou³

et al. 2019

Liver Disease and Surgery [Working Title]

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Liver transplantation constitutes the most effective and indispensable treatment of end-stage liver disease (ESLD). Major advances in surgical techniques, anesthesiological management, postoperative care, immunosuppression, and diagnostic approach have led to increased overall survival of patients. Postoperative care poses a great challenge since detrimental occurrences that need prompt treatment may affect the graft or distant organ functionality. Adequate graft function is strongly associated with distant organ restoration and rapid patient recovery. In the ICU setting, the main focal points are hemodynamic stabilization, coagulation and electrolyte disturbances correction, respiratory support, early weaning from mechanical ventilation, and evaluation of graft functionality. It is of paramount importance to facilitate early graft recovery, recognize and promptly treat systematic complications and life-threatening sequelae, and individualize treatment protocols considering graft quality, donor's and recipient's health status, and potential co-morbidities. To achieve those goals, technological advancements in continuous patient monitoring, graft functionality, and its metabolic reserves must be assimilated and implemented in the ICU.

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Section: Ventilatory Support and Weaning From Mechanical Ventilationmentioning

confidence: 99%

Section: Ventilatory Support and Weaning From Mechanical Ventilationmentioning

confidence: 99%

Management of Patients with Liver Transplantation in ICU

Karapanagiotou¹,

Pitsoulis²,

Vasileiou³

et al. 2019

Liver Disease and Surgery [Working Title]

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“…Pulmonary complications constitute a major cause of morbidity and mortality in end-stage liver disease (ESLD) after liver transplantation, with a frequency of 42.1% to 96.5%. [1][2][3][4][5][6][7][8][9][10][11] To predict for post-transplantation pulmonary complications, many risk factors have been identified, including age, 1,4,7,9,11 history of smoking, 1,4,9,12 history of preexisting lung disease, 1,4,7,9,12,13 history of diabetes mellitus, 1,4,9,14 acute renal failure (requiring dialysis), 1,4,6,9,14 acute respiratory failure (requiring mechanical ventilation support, pre-transplant), 9,14 and severity of liver disease. 1,4,[7][8][9] Laboratory abnormalities that are commonly associated with pulmonary complications include elevations in serum total bilirubin, 6,9 serum creatinine, 6,9 and international normalized rati...…”

Section: Introductionmentioning

confidence: 99%

“…1,4,[7][8][9] Laboratory abnormalities that are commonly associated with pulmonary complications include elevations in serum total bilirubin, 6,9 serum creatinine, 6,9 and international normalized ratio (INR), 1,7,9 used in the calculation of the Model for End-Stage Liver Disease (MELD). 15 Perioperative risk factors encompass fluid balance (ie, intraoperative bleeding volume, 4,9,16,17 intraoperative fluid infusion volume, 4,8,9 intraoperative blood transfusion volume, 4,8,9,11,16 and perioperative fluid retention. 4,9,16,18 ) Post-transplantation pleural effusions are associated with increased mortality (35.7%) although to a lesser extent compared to other pulmonary complications.…”

Section: Introductionmentioning

confidence: 99%

Pleural Effusions Following Liver Transplantation: A Single-Center Experience

Lui

Spaho

Hakimian

et al. 2020

J Intensive Care Med

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Introduction: This was a single-center retrospective study to evaluate incidence, prognosis, and risk factors in patients with postoperative pleural effusions, a common pulmonary complication following liver transplantation. Methods: A retrospective review was performed on 374 liver transplantation cases through a database within the timeframe of January 1, 2009 through December 31, 2015. Demographics, pulmonary and cardiac function testing, laboratory studies, intraoperative transfusion/infusion volumes, postoperative management, and outcomes were analyzed. Results: In the immediate postoperative period, 189 (50.5%) developed pleural effusions following liver transplantation of which 145 (76.7%) resolved within 3 months. Those who developed pleural effusions demonstrated a lower fibrinogen (149.6 ± 66.3 mg/dL vs 178.4 ± 87.3 mg/dL; P = .009), total protein (5.8 ± 1.0 mg/dL vs 6.1 ± 1.2 mg/dL; P = .04), and hemoglobin (9.8 ± 1.8 mg/dL vs 10.3 ± 1.9 mg/dL; P = .004). There was not a statistically significant difference in 1-year all-cause mortality and in-hospital mortality between liver transplant recipients with and without pleural effusions. Liver transplant recipients who developed pleural effusions had a longer hospital length of stay (16.4 ± 10.9 days vs 14.0 ± 16.5 days; P = .1), but the differences were not statistically significant. However, there was a significant difference in tracheostomy rates (11.6% vs 5.4%; P = .03) in recipients who developed pleural effusions compared to recipients who did not. Conclusions: In summary, pleural effusions are common after liver transplantation and are associated with increased morbidity. Pre- and intraoperative risk factors can offer both predictive and prognostic value for post-transplantation pleural effusions. Further prospective studies will be needed to further evaluate the relevance of these findings to limit instances of postoperative pleural effusions.

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“…[5][6][7][8] These complications increase morbidity, prolong mechanical ventilation, intensive care unit (ICU) stay and hospitalization, and significantly reduce short-term survival. 1,2,9,10 Pleural effusion has been reported as the most common pulmonary complication with the prevalence of 32-47% in adult LT recipients. [2][3][4]7 Pleural effusion develops mainly in the right side during the first week after LT but most do not require therapeutic interventions such as thoracentesis and chest tube placement.…”

Section: Introductionmentioning

confidence: 99%

<p>Risk Factors of Pleural Effusion Following Pediatric Liver Transplantation and the Perioperative Outcomes</p>

Thirapattaraphan¹,

Srina²,

Boonthai³

et al. 2020

TRRM

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Background: Pediatric liver transplantation (LT) has been accepted as a definitive treatment for end-stage liver disease. Pleural effusion is a common pulmonary complication following LT in children. The objectives of the study were to identify prevalence of post-LT pleural effusion, risk factors, and the impact on patients' outcomes. Methods: A retrospective study was conducted in 107 pediatric patients who underwent LT at our center between March 2001 and June 2018. They were categorized into pleural effusion and non-pleural effusion groups. Preoperative and perioperative data, intraoperative findings, liver graft characteristics, and perioperative outcomes were compared between the two groups. Results: Post-LT pleural effusion occurred in 64 (59.8%) patients. There were more patients with PELD score ≥ 18 in the pleural effusion group (68.8 vs 48.8%, P=0.039). Other preoperative and perioperative data were not significantly different. The pleural effusion group had a higher rate of reoperation than non-pleural effusion group (55.6 vs 30.9%, P=0.013). Median oxygen dependence time, length of ICU and hospital stay were significantly longer in the pleural effusion group (18.5 vs 7.0, 10 vs 7 and 48 vs 34 days, respectively, P <0.05). However, mortality was not significantly different. Among the patients with pleural effusion, median time to extubation, oxygen dependence time, length of ICU and hospital stay were significantly longer in those who required therapeutic interventions than those without interventions (12 vs 3, 31 vs 10, 17 vs 8, and 60 vs 43 days, respectively, P <0.05). Conclusion: Pleural effusion following pediatric LT is common and its potential risk factor is PELD score at LT ≥ 18. Post-LT pleural effusion is associated with prolonged oxygen dependence time, ICU stay and hospital stay, particularly those who required therapeutic interventions.

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Intensive Care of Pulmonary Complications Following Liver Transplantation

Cited by 19 publications

References 167 publications

Management of Patients with Liver Transplantation in ICU

Management of Patients with Liver Transplantation in ICU

Pleural Effusions Following Liver Transplantation: A Single-Center Experience

<p>Risk Factors of Pleural Effusion Following Pediatric Liver Transplantation and the Perioperative Outcomes</p>

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