Department of Pulmonology and Pulmonary Function Testing, University Hospital of Tours, France.
Department of Digestive Surgery and Liver Transplantation, University Hospital of Tours, France; INSERM U1082, Poitiers, France; FHU SUPPORT, Tours-Poitiers-Limoges, France; University of Tours, Tours, France.
Respir Med Res. 2024 Jun;85:101089. doi: 10.1016/j.resmer.2024.101089. Epub 2024 Feb 7.
Severe early complications are common after liver transplantation (LT) and are a key determinant of LT-related morbidity and mortality. The aim of this study was to assess whether lung function measured in the pre-operative period predicted complicated outcomes in the first month after LT.
Patients with mild-to-moderate liver disease (Model for End stage Liver Disease-MELD score≤30) who underwent LT between October 2015 and May 2020 in a single centre were retrospectively included. The primary endpoint was the occurrence of severe early complications after LT defined by mechanical ventilation duration > 2 days or length of ICU stay > 7 days or reintubation or death < 1 month after LT.
One hundred and twenty patients were included (age 59 [53-64] years, 72 % men). Forty patients (33 %) had early complications after LT. Measured and%predicted hemoglobin-corrected lung transfer capacity for carbon monoxide (DLCOc) were significantly lower in patients with severe early complications after LT. DLCOc was the only variable that associated independently with severe early complications by multivariate analysis. DLCOc under 16.3 ml.min.mmHg predicted respiratory complications with a sensitivity of 67.5 % and a specificity of 62.9 %. DLCOc%pred under 61.5 % had a sensitivity of 56.8 % and a specificity of 72 %. DLCOc independently associated with forced vital capacity (FVC), pulmonary emphysema, and the muscle mass index.
A decrease in DLCOc indicated an increased risk of severe early complications after LT.
肝移植（LT）后常发生严重早期并发症，是 LT 相关发病率和死亡率的关键决定因素。本研究旨在评估术前肺功能测量是否可预测 LT 后 1 个月内的复杂结局。
回顾性纳入 2015 年 10 月至 2020 年 5 月期间在单中心接受 LT 的轻度至中度肝病患者（终末期肝病模型-MELD 评分≤30）。主要终点是 LT 后发生严重早期并发症，定义为机械通气时间>2 天、ICU 住院时间>7 天、再插管或 LT 后<1 个月内死亡。
共纳入 120 例患者（年龄 59[53-64]岁，72%为男性）。40 例（33%）患者 LT 后发生早期并发症。LT 后发生严重早期并发症的患者，实测和%预计血红蛋白校正肺一氧化碳转移量（DLCOc）明显较低。通过多变量分析，DLCOc 是唯一与严重早期并发症独立相关的变量。DLCOc<16.3ml.min.mmHg 预测呼吸并发症的敏感性为 67.5%，特异性为 62.9%。DLCOc%预测值<61.5%的敏感性为 56.8%，特异性为 72%。DLCOc 与用力肺活量（FVC）、肺气肿和肌肉质量指数独立相关。
DLCOc 降低表明 LT 后严重早期并发症的风险增加。
