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

Alfonso Wolfango Avolio, Rita Gaspari, Luciana Teofili, Giuseppe Bianco, Giorgia Spinazzola, Paolo Maurizio Soave, Gianfranco Paiano, Alessandra Gioia Francesconi, Andrea Arcangeli, Nicola Nicolotti, Massimo Antonelli

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSION: 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.

Original languageEnglish
Pages (from-to)e0211678
JournalPLoS One
Volume14
Issue number2
DOIs
Publication statusPublished - 2019

Keywords

  • Female
  • Humans
  • Length of Stay
  • Liver Transplantation/adverse effects
  • Male
  • Middle Aged
  • Postoperative Complications/diagnosis
  • Prognosis
  • Respiratory Insufficiency/diagnosis
  • Risk Factors
  • Survival Analysis

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