Ulubay Gaye, Kirnap Mahir, Er Dedekarginoglu Balam, Kupeli Elif, Oner Eyuboglu Fusun, Haberal Mehmet
From the Department of Pulmonary Diseases, Baskent University, Ankara, Turkey.
Exp Clin Transplant. 2015 Nov;13 Suppl 3:110-4. doi: 10.6002/ect.tdtd2015.P64.
Cardiovascular and respiratory system complications are the most common causes of early mortality after liver transplant. We evaluated the causes of respiratory failure as an early postoperative pulmonary complication in liver transplant recipients.
Patients who underwent orthotropic liver transplant between 2001 and 2014 were retrospectively evaluated. Clinical and demographic variables and pulmonary complications at the first and second visit after transplant were noted. The first visit was within the first week and the second was between 1 and 4 weeks after transplant. An arterial oxygen saturation value below 90% in room air for at least 1 day was considered a medically significant respiratory failure.
Our study included 204 (148 men and 56 women; mean age 43.0.4 ± 13.06 y) adult liver transplant recipients (46 from deceased and 158 from living donors). At the first visit after transplant, 161 patients (79%) had postoperative pulmonary complications, including pleural effusion accompanied by atelectasis (47.1%), only atelectasis (17.2%), and only pleural effusion (10.3%). At the second visit, complications included atelectasis associated with pleural effusion (12.3%) and pneumonia (12.3%). All patients had documented respiratory failure at the first visit, and 92 patients (45.1%) had respiratory failure at the second visit. Causes of respiratory failure at the first visit included atelectasis in 35 patients (17.2%) and atelectasis accompanied by pleural effusion in 96 patients (47.1%). At the second visit, 25 of 161 patients (25.3%) had respiratory failure due to pneumonia. Other causes included atelectasis accompanied by pleural effusion (24.2%) and pleural effusion (23.2%). Ninety-seven patients had no pulmonary complications. The mortality rate was 6.4% within the first visit and 8.7% within the second visit.
Pneumonia, atelectasis, and pleural effusion can cause respiratory failure within the first month after liver transplant. Early pulmonary examination, diagnosis, and treatment can improve patient survival.
心血管和呼吸系统并发症是肝移植术后早期死亡的最常见原因。我们评估了肝移植受者术后早期肺部并发症——呼吸衰竭的原因。
对2001年至2014年间接受原位肝移植的患者进行回顾性评估。记录移植后首次和第二次就诊时的临床和人口统计学变量以及肺部并发症。首次就诊在第一周内，第二次就诊在移植后1至4周之间。在室内空气中动脉血氧饱和度值低于90%至少1天被视为具有医学意义的呼吸衰竭。
我们的研究纳入了204例成年肝移植受者（148例男性和56例女性；平均年龄43.04±13.06岁）（46例来自已故供体，158例来自活体供体）。移植后首次就诊时，161例患者（79%）有术后肺部并发症，包括伴有肺不张的胸腔积液（47.1%）、单纯肺不张（17.2%）和单纯胸腔积液（10.3%）。第二次就诊时，并发症包括与胸腔积液相关的肺不张（12.3%）和肺炎（12.3%）。所有患者在首次就诊时均有记录的呼吸衰竭，92例患者（45.1%）在第二次就诊时出现呼吸衰竭。首次就诊时呼吸衰竭的原因包括35例肺不张（17.2%）和96例伴有胸腔积液的肺不张（47.1%）。第二次就诊时，161例患者中有25例（25.3%）因肺炎导致呼吸衰竭。其他原因包括伴有胸腔积液的肺不张（24.2%）和胸腔积液（23.2%）。97例患者无肺部并发症。首次就诊时死亡率为6.4%，第二次就诊时为8.7%。
肺炎、肺不张和胸腔积液可在肝移植后第一个月内导致呼吸衰竭。早期肺部检查、诊断和治疗可提高患者生存率。
