title: The utility of pulmonary function testing in predicting outcomes following liver transplantation.
abstract: Although pulmonary function tests (PFTs) are routinely performed in patients during the evaluation period before liver transplantation (LT), their utility in predicting post-LT mortality and morbidity outcomes is not known. The aim of this study was to determine the impact of obstructive and/or restrictive lung disease on post-LT outcomes. We conducted a retrospective analysis of patients who had pre-LT PFTs and underwent a subsequent LT (2007-2013). We used statistical analyses to determine independent associations between PFT parameters and outcomes (graft/patient survival, time on ventilator, and hospital/intensive care unit [ICU] length of stay [LOS]). A total of 415 LT recipients with available PFT data were included: 65% of patients had normal PFTs; 8% had obstructive lung disease; and 27% had restrictive lung disease. There was no difference in patient and graft survival between patients with normal, obstructive, and restrictive lung disease. However, restrictive lung disease was associated with longer post-LT time on ventilator and both ICU and hospital LOS (P < 0.05). More specific PFT parameters (diffusing capacity of the lungs for carbon monoxide, total lung capacity, and residual volume) were all significant predictors of ventilator time and both ICU and hospital LOS (P < 0.05). Although pre-LT PFT parameters may not predict post-LT mortality, restrictive abnormalities correlate with prolonged post-LT ventilation and LOS. Efforts to identify and minimize the impact of restrictive abnormalities on PFTs might improve such outcomes. Liver Transplantation 22 805-811 2016 AASLD.
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Leila
authors.initials: L
authors.lastname: Kia
authors.affiliation: Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cuttica
authors.affiliation: Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Amy
authors.initials: A
authors.lastname: Yang
authors.affiliation: Departments of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Erica N
authors.initials: EN
authors.lastname: Donnan
authors.affiliation: Departments of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Maureen
authors.initials: M
authors.lastname: Whitsett
authors.affiliation: Departments of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Ajay
authors.initials: A
authors.lastname: Singhvi
authors.affiliation: Departments of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lemmer
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL.|Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Josh
authors.initials: J
authors.lastname: Levitsky
mesh_terms: D000368:Aged; D058625:End Stage Liver Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data*; D016031:Liver Transplantation / Q000009:adverse effects*; D008171:Lung Diseases / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D016019:Survival Analysis