title: Pulmonary complications after elective liver transplantation-incidence, risk factors, and outcome.
abstract: After liver transplantation (LT), postoperative pulmonary complications (PPC) occur in approximately 35% to 50% of the recipients. Among these PPC, pneumonia is the most frequently encountered. Pulmonary dysfunction has also been widely reported among patients awaiting LT. The links between this dysfunction and PPC have not been clearly established. In this present cohort study, we evaluated the incidence and profile of post-LT pneumonia and identified potential preoperative risk factors.
  
  
  METHODS
  The postoperative clinical course of 212 liver transplant recipients between January 2008 and April 2010 was analyzed. These patients were treated in a single intensive care unit and received standardized postoperative care.
  
  
  RESULTS
  During the postoperative period, 47 (22%) patients developed pneumonia, of whom 20 (43%) developed respiratory failure requiring mechanical ventilation. Univariate analysis showed that several preoperative factors (age of recipient, model for end-stage liver disease score, indication for LT, platelet count, and restrictive lung pattern revealed by preoperative pulmonary function tests) and the transfusion (blood units and fresh frozen plasma units) during the operative period were associated with pneumonia. Using multivariate analysis by logistic regression, only a restrictive lung pattern (odds ratio=3.14; 95% confidence interval, 1.51-6.51; P=0.002) and the international normalized ratio measured prior LT (OR=4.95; 95% confidence interval, 1.86-8.59; P=0.0004) were independent predictors of pneumonia after LT.
  
  
  CONCLUSIONS
  Pneumonia is common among patients undergoing LT and is a major cause of morbidity. A restrictive pattern on preoperative pulmonary testing and a higher international normalized ratio measured prior LT were associated with more risk of postoperative pneumonia.
authors.affiliation: AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France. eric.levesque@pbr.aphp.fr
authors.forename: Eric
authors.initials: E
authors.lastname: Levesque
authors.forename: Emir
authors.initials: E
authors.lastname: Hoti
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.forename: Isabelle
authors.initials: I
authors.lastname: Honore
authors.forename: Bruno
authors.initials: B
authors.lastname: Guignard
authors.forename: Eric
authors.initials: E
authors.lastname: Vibert
authors.forename: Philippe
authors.initials: P
authors.lastname: Ichai
authors.forename: Fadi
authors.initials: F
authors.lastname: Antoun
authors.forename: Faouzi
authors.initials: F
authors.lastname: Saliba
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D013147:Spirometry; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult