Postoperative respiratory failure in liver transplantation: Risk factors and effect on prognosis

• DOI: 10.1371/journal.pone.0211678
• Publication Date: 2019-02-11T18:33:35Z
• Authors: Alfonso Wolfango ...; Rita Gaspari; Luciana Teofili; Giuseppe Bianco; Giorgia Spinazzola; Paolo Maurizio Soave; Gianfranco Paiano; Alessandra Gioia ...; Andrea Arcangeli; Nicola Nicolotti; Massimo Antonelli
• Keywords: Male; Science; Q; R; Female Humans Length of Stay Liver Transplantation/adverse effects* Liver Transplantation/mortality Male Middle Aged Postoperative Complications/diagnosis Postoperative Complications/etiology* Postoperative Complications/mortality Prognosis Respiratory Insufficiency/diagnosis Respiratory Insufficiency/etiology* Respiratory Insufficiency/mortality Risk Factors Survival Analysis; Length of Stay; Middle Aged; Prognosis; Survival Analysis; Liver Transplantation; 3. Good health; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; LIVER TRANSPLANTATION, RESPIRATORY COMPLICATION, RISK FACTORS, OUTCOME; Risk Factors; Medicine; Humans; Female; Respiratory Insufficiency; Research Article

Postoperative respiratory failure (PRF, namely mechanical ventilation >48 hours) significantly affects morbidity and mortality in liver transplantation (LTx). Previous studies analyzed only one or two categories of PRF risk factors (preoperative, intraoperative or postoperative ones). The aims of this study were to identify PRF predictors, to assess the length of stay (LoS) in ICU and the 90-day survival according to the PRF in LTx patients.Two classification approaches were used: systematic classification (recipient-related preoperative factors; intraoperative factors; logistic factors; donor factors; postoperative ICU factors; postoperative surgical factors) and patient/organ classification (patient-related general factors; native-liver factors; new-liver factors; kidney factors; heart factors; brain factors; lung factors). Two hundred adult non-acute patients were included. Missing analysis was performed. The competitive role of each factor was assessed.PRF occurred in 36.0% of cases. Among 28 significant PRF predictors at univariate analysis, 6 were excluded because of collinearity, 22 were investigated by ROC curves and by logistic regression analysis. Recipient age (OR = 1.05; p = 0.010), female sex (OR = 2.75; p = 0.018), Model for End-Stage Liver Disease (MELD, OR = 1.09; p<0.001), restrictive lung pattern (OR = 2.49; p = 0.027), intraoperative veno-venous bypass (VVBP, OR = 3.03; p = 0.008), pre-extubation PaCO2 (OR = 1.11; p = 0.003) and Model for Early Allograft Function (MEAF, OR = 1.37; p<0.001) resulted independent PRF risk factors. As compared to patients without PRF, the PRF-group had longer LoS (10 days IQR 7-18 versus 5 days IQR 4-7, respectively; p<0.001) and lower day-90 survival (86.0% versus 97.6% respectively, p<0.001).In conclusion, MELD, restrictive lung pattern, surgical complexity as captured by VVBP, pre-extubation PaCO2 and MEAF are the main predictors of PRF in non-acute LTx patients.