title: Acute respiratory distress syndrome after orthotopic liver transplantation.
abstract: OBJECTIVE
  Acute respiratory distress syndrome (ARDS) is a devastating complication with substantial mortality. The aims of this study were to identify the incidence, preoperative and intraoperative risk factors, and impact of ARDS on outcomes in patients after orthotopic liver transplantation (OLT).
  
  
  METHODS
  Adult OLT patients between January 2004 and October 2013 at our center were included. Postoperative ARDS was determined using the criteria proposed by the Berlin Definition. Multivariate logistic models were used to identify preoperative and intraoperative risk factors for ARDS.
  
  
  RESULTS
  Of 1726 patients during the study period, 71 (4.1%) developed ARDS. In the preoperative model, encephalopathy (odds ratio [OR], 2.22; P = .022), preoperative requirement of intubation (OR, 2.06; P = .020), and total bilirubin (OR, 1.02; P = .003) were independent risk factors. In the intraoperative model, large pressor bolus was the sole risk factor for ARDS (OR, 2.69; P = .001). Postoperatively, patients with ARDS had a 2-fold increase in 1-year mortality, mechanical ventilation time, and length of hospital stay.
  
  
  CONCLUSIONS
  Acute respiratory distress syndrome occurred at a rate of 4.1% following OLT in adult patients and was associated with preoperative encephalopathy, requirement of intubation, and total bilirubin and intraoperative large boluses of pressors. Acute respiratory distress syndrome was associated with increased mortality, longer ventilation time, and hospital stay.
authors.affiliation: Department of Anesthesiology, Shandong University Qianfoshan Hospital, Jinan, Shandong, PR China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhao
authors.affiliation: Department of Anesthesiology and Peroperative Medicine, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Xupeng
authors.initials: X
authors.lastname: Ge
authors.affiliation: Department of Anesthesiology and Peroperative Medicine, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Sun
authors.affiliation: Department of Surgery, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Vatche G
authors.initials: VG
authors.lastname: Agopian
authors.affiliation: Department of Anesthesiology, Shandong University Qianfoshan Hospital, Jinan, Shandong, PR China.
authors.forename: Yuelan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
authors.forename: Min
authors.initials: M
authors.lastname: Yan
authors.affiliation: Department of Surgery, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
authors.affiliation: Department of Anesthesiology and Peroperative Medicine, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors.forename: Randolph H
authors.initials: RH
authors.lastname: Steadman
authors.affiliation: Department of Anesthesiology and Peroperative Medicine, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: vxia@mednet.ucla.edu.
authors.forename: Victor W
authors.initials: VW
authors.lastname: Xia
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D016031:Liver Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012121:Respiration, Artificial / Q000009:adverse effects; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors
keywords: Acute respiratory distress syndrome; Liver transplantation; Perioperative management; Postoperative complication; Retrospective study; Risk factors