Postoperative Pulmonary Complications After Liver Transplantation: Assessment of Risk Factors for Mortality

Aydın, Cemalettin; Otan, Emrah; Akbulut, Sami; Karakas, Serdar; Kayaalp, Cüneyt; Karagül, Servet; Çolak, Cemil; Gönültaş, Fatih; Yilmaz, Sezai

doi:10.1016/j.transproceed.2015.04.058

Cited by 26 publications

(45 citation statements)

References 12 publications

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“…The considerable difference between laboratory MELD score and match MELD score in our study group can be best explained by the fact that 34.2% of all patients received allocation via MELD score exception. MELD score itself has been shown to be a risk factor for the development of pulmonary complications after LT [4,6,30,32]. Possible other risk factors contributing to the high incidence of pleural effusions found in our study cohort include the relatively high incidences of pre-transplant mechanical ventilation or renal insufficiency and high numbers of intraoperative blood transfusions [6,7,33,34].…”

Section: Discussionmentioning

confidence: 72%

“…In our cohort, we found a significantly higher incidence of drainage-relevant effusions. This is most likely because the patients in our cohort were sicker, as reflected by higher MELD scores [30,32,33]. In the German liver transplant allocation system, the MELD score is differentiated between a calculated laboratory MELD score and a match MELD score with exceptions for patients whose disease severity is not adequately reflected by the laboratory MELD score.…”

Section: Discussionmentioning

confidence: 99%

“…In the existing literature, reported incidences for post-LT pleural effusion vary notably from 18.4% to 96.5% [5,29], but are mostly described as between 35% and 70% [6][7][8]30,31]. Among all analyzed patients between 9.1% and 32.4% required a pleural drainage, which corresponds to 18% to 52% of patients with pleural effusion [5][6][7][8]31].…”

Section: Discussionmentioning

confidence: 99%

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Perioperative Pleural Drainage in Liver Transplantation: A Retrospective Analysis from a High-Volume Liver Transplant Center

et al. 2020

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Background: Pleural effusions represent a common complication after liver transplantation (LT) and chest drain (CD) placement is frequently necessary. Material/Methods: In this retrospective cohort study, adult LT recipients between 2009 and 2016 were analyzed for pleural effusion formation and its treatment within the first 10 postoperative days. The aim of the study was to compare different settings of CD placement with regard to intervention-related complications. Results: Overall, 597 patients met the inclusion criteria, of which 361 patients (60.5%) received at least 1 CD within the study period. Patients with a MELD >25 were more frequently affected (75.7% versus 56.0%, P<0.001). Typically, CDs were placed in the intensive care unit (ICU) (66.8%) or in the operating room (14.1% during LT, 11.5% in the context of reoperations). In total, 97.0% of the patients received a right-sided CD, presumably caused by local irritations. Approximately one-third (35.4%) of ICU-patients required pre-interventional optimization of coagulation. Of the 361 patients receiving a CD, 15 patients (4.2%) suffered a post-interventional hemorrhage and 6 patients (1.4%) had a pneumothorax requiring further treatment. Less complications were observed when the CD was performed in the operating room compared to the ICU: 1 out 127 patients (0.8%) versus 20 out of 332 patients (6.0%); P=0.016. Conclusions: CD placement occurring in the operating room was associated with fewer complications in contrast to placement occurring in the ICU. Planned CD placement in the course of surgery might be favorable in high-risk patients.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Perioperative Pleural Drainage in Liver Transplantation: A Retrospective Analysis from a High-Volume Liver Transplant Center

et al. 2020

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“…The incidence of PPCs, including pleural effusion, atelectasis, pneumonia, acute lung injury (ALI), and acute respiratory distress syndrome (ARDS), is higher than 80%, with a wide variation across reports depending on the definition adopted [ 1 , 2 ]. PPCs are associated with long-term mechanical ventilation, long hospital stays, and poor outcomes [ 3 , 4 ]. The origin of PPCs is multifactorial.…”

Section: Introductionmentioning

confidence: 99%

N-Acetylcysteine inhalation improves pulmonary function in patients received liver transplantation

Wei

Chen

et al. 2018

Bioscience Reports

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Postoperative pulmonary complications (PPCs) following orthotopic liver transplantation (OLT) are associated with high morbidity and mortality rates. The effect of N-acetylcysteine (NAC) inhalation on the incidence of PPCs and the outcomes of patients undergoing OLT is unknown. This prospective randomized controlled clinical trial was conducted to investigate the effect of NAC inhalation during OLT on PPCs. Sixty patients were randomly assigned to the NAC group (n = 30) or the control group (n = 30) to receive inhaled NAC or sterilized water, respectively, for 30 min before surgery and 3 h after reperfusion. The incidence of early PPCs and outcomes including survival rate were assessed. Biomarkers including tumor necrosis factor (TNF)-α, interleukin (IL)-8, Clara cell secretory protein (CC16), intercellular adhesion molecule (ICAM)-1, and superoxide dismutase (SOD) were measured in exhaled breath condensate (EBC) at T1 (before surgery) and T2 (at the end of operation) as well as in serum at T1, T2, T3 (12 h after operation), and T4 (24 h after operation). A total of 42 patients (20 in the NAC group and 22 in the control group) were enrolled in the final analysis. Atomization inhaled NAC significantly reduced the incidence of PPCs after OLT. The levels of TNF-α, IL-8, CC16, and ICAM-1 in EBC were significantly lower, and SOD activity was higher, at T2 in the NAC group; similar data were found in serum at T2, T3, and T4. In summary, perioperative NAC inhalation may reduce the incidence of PPCs and improve patient outcomes after OLT.

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“…Using conventional broad criteria for diagnosis of PPCs, any postoperative pulmonary abnormality that adversely affects the clinical course of a patient could be defined as a PPC, including respiratory failure, pneumonia, atelectasis, pneumothorax, pleural effusion, acute lung injury (ALI), acute respiratory distress syndrome (ARDS), and various other forms of upper airway obstruction [ 2 – 4 ]. Previous studies have reported varying incidences of PPCs after liver transplantation, ranging from 42.1% to 86.7%, in accordance with broad diagnostic criteria; the corresponding fatality rates have been reported to be 25% to 52.9% [ 5 , 6 ]. In addition, it was also reported that some PPCs, such as pleural effusion, were non-fatal and had better clinical prognosis than the fatal ones, like ARDS [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Retrospective Comparative Study on Postoperative Pulmonary Complications After Orthotopic Liver Transplantation Using the Melbourne Group Scale (MGS-2) Diagnostic Criteria

Chen

Wei

et al. 2018

Ann Transplant

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BackgroundPostoperative pulmonary complications (PPCs) after orthotopic liver transplantation (OLT) are associated with poor postoperative survival. However, there are no standard criteria for diagnosis of PPCs. This retrospective study aimed to explore the reliability of the Melbourne Group Scale version 2 (MGS-2) for determining PPCs after OLT.Material/MethodsA total of 121 patients were divided into 3 groups. In the PPC and non-PPC groups, PPCs were determined to be present or absent in accordance with both the MGS-2 and the conventional broad criteria for diagnosis of PPCs; in the potential-PPC group, PPCs were determined to be present only in accordance with the conventional broad criteria. The perioperative risk factors for PPCs and prognosis of patients in potential-PPC group were all compared with non-PPC groups and PPC groups.ResultsThe preoperative characteristics of patients in the potential-PPC group were similar to those in non-PPC group. The length of intensive care unit stay (2.26±0.22 vs. 4.75±0.47 days; P=0.017), duration of hospitalization (33.33±1.70 vs. 48.78±2.53 days; P<0.001), and treatment cost (28.01±1.78 vs. 38.35±1.85×10 000 yuan; P=0.018) were significantly less in the potential-PPC group than in the PPC group. Furthermore, in accordance with the MGS-2 criteria for diagnosis of PPCs, patients with PPCs showed poorer overall survival rates than those without (P=0.038).ConclusionsThe MGS-2 appears to be a more suitable and reliable tool for diagnosis of PPCs and to identify the post-OLT patients with poorer perioperative characteristics and prognosis.

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Postoperative Pulmonary Complications After Liver Transplantation: Assessment of Risk Factors for Mortality

Cited by 26 publications

References 12 publications

Perioperative Pleural Drainage in Liver Transplantation: A Retrospective Analysis from a High-Volume Liver Transplant Center

Perioperative Pleural Drainage in Liver Transplantation: A Retrospective Analysis from a High-Volume Liver Transplant Center

N-Acetylcysteine inhalation improves pulmonary function in patients received liver transplantation

Retrospective Comparative Study on Postoperative Pulmonary Complications After Orthotopic Liver Transplantation Using the Melbourne Group Scale (MGS-2) Diagnostic Criteria

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