title: Postoperative Pulmonary Complications After Liver Transplantation: Assessment of Risk Factors for Mortality.
abstract: BACKGROUND
  The aim of this study was to identify the risk factors related to mortality in liver transplant (LT) patients with post-transplantation pulmonary complications.
  
  
  METHODS
  Patients who underwent liver transplantation in our clinic between January 2010 and January 2012 were retrospectively reviewed for post-transplantation pulmonary complications. Demographic, clinical, radiologic, and postoperative chart data of 153 patients with pulmonary complications were analyzed using an independent samples Student t test, Pearson's χ(2) test, Fisher's exact test, and Yate's corrected χ(2) test. Mortality was analyzed using a multiple logistic regression model. The best-fit breakpoint resulting in a cut-off value for the variables of interest was determined using ROC curves and the Youden index.
  
  
  RESULTS
  The 153 patients with pulmonary complication were divided into 2 groups: mortality (n = 53) and survival (n = 100). Univariate analyses showed significant differences between these 2 groups with respect to MELD score (P = .035), duration of mechanical ventilation (P > .001), pneumonia (P = .01), and endotracheal culture results (P = .001). In the multivariate analysis, hemoglobin (P = .03, odds ratio [OR]: 1.239), MELD score (P = .027, OR: 1.064), duration of mechanical ventilation (P = .003, OR: 1.091), and age (P = .042, OR: 1.001) were significant risk factors for mortality. The best-fit breakpoint analysis yielded cut-off values for hemoglobin (>11.2, sensitivity: 50.9%, specificity: 70%), MELD score (>16, sensitivity: 73.6%, specificity: 42%) and duration of mechanical ventilation (>3, sensitivity: 62.3%, specificity: 76%).
  
  
  CONCLUSIONS
  Advanced age, high hemoglobin level, high MELD score, and long-term mechanical ventilation are significant risk factors for mortality in liver transplant patients with postoperative pulmonary complications.
authors.affiliation: Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Aydin
authors.affiliation: Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey. Electronic address: otanemrah@yahoo.de.
authors.forename: E
authors.initials: E
authors.lastname: Otan
authors.affiliation: Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Akbulut
authors.affiliation: Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Karakas
authors.affiliation: Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Kayaalp
authors.affiliation: Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Karagul
authors.affiliation: Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Colak
authors.affiliation: Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey.
authors.forename: F
authors.initials: F
authors.lastname: Gonultas
authors.affiliation: Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Yilmaz
mesh_terms: D000293:Adolescent; D000328:Adult; D058625:End Stage Liver Disease / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008171:Lung Diseases / Q000209:etiology* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012372:ROC Curve; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult