Early Respiratory Complications After Liver Transplantation

Abstract

Liver transplantation has a major survival benefit in patients with end stage liver disease (ESLD) who would otherwise have a high short term mortality rate. Cirrhotic patients are liable for many pulmonary complications such as about a third of patients with decompensated cirrhosis have reduced arterial oxygen saturation and are sometimes cyanosed and causes include hepato-pulmonary syndrome (HPS). Despite advances in surgical techniques of liver transplantation anesthiological management ,the lung may still suffer throughout the peri-operative period from various types of injury with different ensuing ventilatory impairments and different clinical outcomes . Respiratory complications of liver cirrhosis include: Hypoxia ,intra-pulmonary shunting ,ventilation perfusion mismatch ,reduced transfer factor , pleural effusion , raised diaphragms, basal atelectasis , primary pulmonary hypertension , porto-pulmonary shunting and chest X-ray mottling. There are many risk factors for post liver transplantation respiratory complications including:  Pre-operative : age , sex , history of smoking , aetiology of cirrhosis alpha-1 antitrypsin deficiency and presence of pulmonary complications of cirrhosis (HPS).  Intra-operative : surgical procedures , intra operative fluid transfusion volume , intra operative blood transfusion , peri-operative fluid balance , intra operative fluid retention and intra operative bleeding volume .  Post operative : excessive fluid transfusion , post operative duration of mechanical ventilation , occurance of acute rejection or acute renal failure. The Incidence of post operative pulmonary complications varies widely from 13 to 70%. Early post operative respiratory complications in liver transplant patients include : pleural effusion , atelectasis , pulmonary edema , acute respiratory distress syndrome and pneumonia . There are many strategies to prevent post-operative pulmonary complications including:  Pre-operative strategies :pulmonary rehabilitation prior to OLT .  Intra-operative strategies: reduction in the degree of surgical insult , in the level of aggressiveness , in the duration of the procedure and in the amount of blood loss .  post-operative strategies: proper ventilation: early extubation , lung expantion maneuvers , deep breathing exercise , chest percussion and vibration and invasive mechanical ventilation . Adequate pain relief , optimal hemodynamic and fluid management , improvement of general health and nutrition. References