Preoperative pulmonary evaluation of liver transplant candidates: Results from 341 adult patients

Bozbas, Serife Savas; Yılmaz, Eylül Bozkurt; Dogrul, Ilgaz; Ergür, Figen Öztürk; Savas, Nurten; Eyüboğlu, Füsun Öner; Haberal, Mehmet

doi:10.12659/aot.882000

Cited by 20 publications

(7 citation statements)

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“…Decreased DLCO and DLCO/VA values have been reported in patients with liver cirrhosis ( 6 , 21 , 23 , 24 , 25 , 34 , 38 , 39 , 42-44 ). Similar to spirometric parameters, in some studies, alterations in DLCO and DLCO/VA values have been found to be associated with the severity of liver cirrhosis as assessed by various scores, clinical features and laboratory data ( 23 , 24 , 27 , 38 , 43 , 44 ).…”

Section: Diffusing Capacity For Carbon Monoxidementioning

confidence: 90%

“…Massive hepatomegaly, ascites, atelectasis and pleural effusions all reduce lung compliance in patients with liver cirrhosis ( 25 ). Restrictive dysfunction has been linked to the increasing severity of liver disease and consequences, such as encephalopathy, ascites and hepatic hydrothorax.…”

Section: Pathogenetic Mechanisms For Pft Changes In Patients With Liv...mentioning

confidence: 99%

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Pulmonary function testing in patients with liver cirrhosis (Review)

Georgakopoulou

Asimakopoulou

2023

Med Int

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Liver cirrhosis is a common long-term outcome of chronic hepatic inflammation. Patients with liver cirrhosis may also have pulmonary complications. There are several reasons for pulmonary dysfunction in liver cirrhosis, including intrinsic cardiopulmonary dysfunction unrelated to liver disease and specific disorders related to the presence of liver cirrhosis and/or portal hypertension. The most prevalent and clinically significant pulmonary complications are hepatic hydrothorax, hepatopulmonary syndrome, spontaneous pulmonary empyema and portopulmonary hypertension. Pulmonary function tests (PFTs) have traditionally been used to assess the lung function of patients with liver cirrhosis. To the best of our knowledge, the present review is the first to detail all types of PFTs performed in patients with liver cirrhosis and discuss their clinical significance. Patients with liver cirrhosis have reduced values of spirometric parameters, diffusion capacity for carbon monoxide (DLCO), lung volumes, maximal inspiratory pressure and maximal expiratory pressure. Furthermore, they have a higher closing volume, a greater airway occlusion pressure 0.1 sec after the onset of inspiratory flow and greater exhaled nitric oxide values. In order to improve pulmonary function, patients with ascites may require therapeutic paracentesis. Such findings should be considered when evaluating individuals with liver disease, particularly those who may require surgery. Poor lung function, particularly restrictive lung disease, can have an impact on post-transplant outcomes, such as ventilator time, length of hospital duration and post-operative pulmonary complications; thus, the transplant care team needs to be aware of its prevalence and relevance.

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Section: Diffusing Capacity For Carbon Monoxidementioning

confidence: 90%

Section: Pathogenetic Mechanisms For Pft Changes In Patients With Liv...mentioning

confidence: 99%

Pulmonary function testing in patients with liver cirrhosis (Review)

Georgakopoulou

Asimakopoulou

2023

Med Int

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“…This preoperative condition, compounded by the extensive duration and complexity of the LT procedure, significantly escalates the risk of postoperative complications, especially respiratory dysfunctions. These complications are critical determinants of both acute and chronic postoperative morbidity and mortality rates, underscoring their clinical importance (2)(3)(4)(5). The duration of the surgery is a key factor; longer surgical times correlate with an increased risk of chest complications in LT recipients, exacerbating postoperative morbidity and mortality (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Frequency of Chest Complications after Liver Transplantation

Hassan,

Murtaza,

Haider

et al. 2024

JHRR

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Background: Liver transplantation is a critical intervention for patients with advanced liver disease. However, postoperative complications, particularly pulmonary complications, significantly impact patient outcomes. Understanding these complications is essential for improving post-transplant care. Objective: To investigate the prevalence and nature of pulmonary complications in liver transplant recipients and to identify potential risk factors associated with these complications. Methods: This study was conducted at the Hepatobiliary and Liver Transplant Centre, Shaikh Zayed Hospital, Lahore, Pakistan, over a six-month period. A case series design with non-probability purposive sampling was employed. The sample size, determined using the WHO Sample Size Tool, was set at 100 participants, given logistical constraints. Data collection involved detailed postoperative assessments to identify pulmonary complications. The study included participants of all sexes and ages awaiting liver transplantation, excluding those undergoing a second transplant. Data analysis was performed using SPSS version 25. Results: Out of 100 liver transplant recipients, 98.5% (n=128) presented with stable vital signs at the time of data collection, while 1.5% (n=2) were unstable. Discharge planning indicated 68.5% (n=89) under observation and 23.1% (n=30) with routine planning. In terms of education, 59.2% (n=77) had 10 years of education, and 16.9% (n=22) were illiterate. Donor health status was excellent in 98.5% (n=128) of cases. Pulmonary complications included respiratory infections (23.8%, n=31), pleural effusion (36.2%, n=47), atelectasis (15.4%, n=20), bronchospasm (7.7%, n=10), and pneumonia (9.2%, n=12). Conclusion: The study highlights a significant incidence of pulmonary complications post-liver transplantation, with pleural effusion, respiratory infections, and atelectasis being the most common. These findings underscore the need for enhanced monitoring and proactive management of pulmonary complications in liver transplant recipients.

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“…Some previous studies have shown that respiratory problems and some breathing patterns prior to surgery are predictors of post-operation pulmonary complications. 4,5 Candidates for liver transplantation routinely undergo a thorough pulmonary assessment before surgery. Pulmonary function tests (PFTs) are usually within normal ranges in these patients.…”

Section: Introductionmentioning

confidence: 99%

“…Pulmonary function tests (PFTs) are usually within normal ranges in these patients. 5 Gas exchange abnormalities are common findings, which can be attributed to decreased total lung capacity, obstructive and restrictive types of abnormalities, gas diffusion impairment, and pulmonary vascular problems in patients with end-stage cirrhosis. 6,7 However, the exact etiology of respiratory abnormalities in liver cirrhosis is still unknown, and further studies are needed to investigate the related contributing factors.…”

Section: Introductionmentioning

confidence: 99%

The Relationship Between Airway Occlusion Pressure and Severity of liver Cirrhosis in Candidates for Liver Transplantation

Gholamipoor

Nassiri-Toosi

Azadi

et al. 2020

Middle East J Dig Dis

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BACKGROUND End-stage cirrhosis is an irreversible condition, and liver transplantation is the only treatment option in for the affected patients. Respiratory problems and abnormal breathing are common findings among these patients. In this study, for the first time, we examined the relationship between the severity of liver cirrhosis and respiratory drive measured by mouth occlusion pressure (P0.1). METHODS This was a cross-sectional study conducted on 50 candidates for liver transplantation who were referred to the pulmonary clinic of Imam Khomeini Hospital for pre-operative pulmonary evaluations. Arterial blood gas analysis (ABG), pulmonary function tests, and measurement of P0.1 were performed for all patients. The severity of liver disease was assessed using the Model for End-Stage Liver Disease (MELD) score. RESULTS The median P0.1 was 5 cm H2 O. P0.1 was negatively associated with PaCO2 (r = -0.466, p = 0.001) and HCO3 - (r = -0.384, p = 0.007), and was positively correlated with forced expiratory volume at 1s (FEV1 )/ forced vital capacity (FVC) (r = 0.282, p = 0.047). There was a strong correlation between P0.1 and MELD score (r = 0.750, p < 0.001). Backward multivariate linear regression revealed that a higher MELD score and lower PaCO2 were associated with increased P0.1. CONCLUSION High levels of P0.1 and strong direct correlation between P0.1 and MELD score observed in the present study are suggestive of the presence of abnormal increased respiratory drive in candidates for liver transplantation, which is closely related to their disease severity.

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Preoperative pulmonary evaluation of liver transplant candidates: Results from 341 adult patients

Cited by 20 publications

References 0 publications

Pulmonary function testing in patients with liver cirrhosis (Review)

Pulmonary function testing in patients with liver cirrhosis (Review)

Frequency of Chest Complications after Liver Transplantation

The Relationship Between Airway Occlusion Pressure and Severity of liver Cirrhosis in Candidates for Liver Transplantation

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