title: Pre-operative risk factors predict post-operative respiratory failure after liver transplantation.
abstract: OBJECTIVE
  Post-operative pulmonary complications significantly affect patient survival rates, but there is still no conclusive evidence regarding the effect of post-operative respiratory failure after liver transplantation on patient prognosis. This study aimed to predict the risk factors for post-operative respiratory failure (PRF) after liver transplantation and the impact on short-term survival rates.
  
  
  METHODS
  The retrospective observational cohort study was conducted in a twelve-bed adult surgical intensive care unit in northern Taiwan. The medical records of 147 liver transplant patients were reviewed from September 2002 to July 2007. Sixty-two experienced post-operative respiratory failure while the remaining 85 patients did not.
  
  
  RESULTS
  Gender, age, etiology, disease history, pre-operative ventilator use, molecular adsorbent re-circulating system (MARS) use, source of organ transplantation, model for end-stage liver disease score (MELD) and Child-Turcotte-Pugh score calculated immediately before surgery were assessed for the two groups. The length of the intensive care unit stay, admission duration, and mortality within 30 days, 3 months, and 1 year were also evaluated. Using a logistic regression model, post-operative respiratory failure correlated with diabetes mellitus prior to liver transplantation, pre-operative impaired renal function, pre-operative ventilator use, pre-operative MARS use and deceased donor source of organ transplantation (p<0.05). Once liver transplant patients developed PRF, their length of ICU stay and admission duration were prolonged, significantly increasing their mortality and morbidity (p<0.001).
  
  
  CONCLUSIONS
  The predictive pre-operative risk factors significantly influenced the occurrence of post-operative respiratory failure after liver transplantation.
authors.affiliation: Department of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Ching-Tzu
authors.initials: CT
authors.lastname: Huang
authors.forename: Horng-Chyuan
authors.initials: HC
authors.lastname: Lin
authors.forename: Shi-Chuan
authors.initials: SC
authors.lastname: Chang
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Lee
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012131:Respiratory Insufficiency / Q000209:etiology*; D012307:Risk Factors; D013624:Taiwan