title: Preoperative pulmonary evaluation of liver transplant candidates: results from 341 adult patients.
abstract: BACKGROUND
  Pulmonary disorders are among the commonly encountered and prognostically important problems in patients with chronic liver disease. To define the prevalence and types of respiratory disorders in patients with advanced liver disease evaluated for liver transplant (LT) candidacy, and to determine factors affecting postoperative outcome.
  
  
  METHODS
  The records of 341 adult patients evaluated for LT candidacy were retrospectively examined. Demographic, clinical and laboratory data including chest X-ray, spirometry and echocardiography results were collected. Postoperative pulmonary complications and mortality rates were determined.
  
  
  RESULTS
  With a mean age of 45.1 years, 73 (21.4%) patients presented with respiratory symptoms or signs. The most common radiographic abnormality on chest X-ray was right diaphragm elevation (53.2%). Hypoxemia was detected in 38.1% of the patients. Pulmonary hypertension was detected in 100 of 327 (30.6%) patients on Doppler echocardiography. There were 141 patients who underwent surgery. Postoperative pulmonary complications developed in 60 patients, with pneumonia being the most prevalent complication (n=28). Smoking, emphysema, abnormal spirometry, pulmonary hypertension, hypoxia and orthodeoxia were found to be factors associated with increased postoperative pulmonary complications (P<0.05 for all). Mortality rate was 24.1% (n=34) and found to be significantly higher in patients who developed a postoperative complication than in those who did not (38.7% vs. 13.8%, respectively; p=0.001).
  
  
  CONCLUSIONS
  The authors' findings indicate that pulmonary disorders impact prognosis and are common in patients evaluated for LT candidacy. Postoperative pulmonary complication is one of the major factors affecting mortality. Therefore, in order to increase the success of the transplant operation, a thorough preoperative pulmonary evaluation is of paramount importance.
authors.affiliation: Department of Pulmonary Medicine, Baskent University Faculty of Medicine, Ankara, Turkey. serifesb@gmail.com
authors.forename: Serife Savas
authors.initials: SS
authors.lastname: Bozbas
authors.forename: Eylul Bozkurt
authors.initials: EB
authors.lastname: Yilmaz
authors.forename: Ilgaz
authors.initials: I
authors.lastname: Dogrul
authors.forename: Figen Ozturk
authors.initials: FO
authors.lastname: Ergur
authors.forename: Nurten
authors.initials: N
authors.lastname: Savas
authors.forename: Fusun
authors.initials: F
authors.lastname: Eyuboglu
authors.forename: Mehmet
authors.initials: M
authors.lastname: Haberal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D000860:Hypoxia / Q000150:complications; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D057234:Preoperative Period; D011379:Prognosis; D011653:Pulmonary Diffusing Capacity; D011859:Radiography; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D055815:Young Adult