الفهرس 
Liiviing Donor Liiver TranspllantatiionOnly 14 pages are availabe for public view
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Abstract
Liver transplantation (LT) is currently the only definite treatment for acute liver failure and chronic end-stage liver diseases. Because of a shortage of liver donations, patients may have to wait for a long time for a liver transplantation. When liver transplantations are performed, the patients are already very sick.(1)
Since respiratory disorders are common and have significant impact on postoperative outcome in patients undergoing liver transplant, a careful preoperative pulmonary assessment is important.(2)
In this study the prevalence of pre transplant and post transplant pulmonary dysfunction and diseases and its impact on outcome of liver transplantation was studied as it has never been studied before in Egypt.
The present study was a retrospective-prospective study design started in March 2012 including adult patients’ candidates for LDLT previously or subsequently in Ain Shams University Specialized Hospital and Egypt Air Specialized Hospital between March 2008 to January 2012 (retrospective part) and in Ain Shams University Specialized Hospital between April 2012 to March 2013 (prospective part). All studied cases are totally projected (251 LDLT recipients).
Different demographic, laboratory and investigational data with special emphases on pulmonary dysfunctions and diseases data was collected from each patient in the prospective part and form the available records in retrospective part. As retrospective data were incomplete, the results were analyzed based on total number in response to each item.
The following results were obtained:
•The mean age of LT candidates was 49 ±7.9, 91.2% of them were males. The mean BMI of them was 27.6±3.8. The most common indication of LT in Egypt HCV cirrhosis.
•Smoking history was noted in 31.9% of patients, coexisting pulmonary disease and DM were recorded in (29.5%, 27.9%) respectively.
• Most of the LDLT recipients were transplanted in Child C (69.3%) with mean preoperative MELD score was (16.9 ± 5.1).
•The most common preoperative spirometric abnormality was restrictive pattern (59.8%). Obstructive pattern was noted to be the least common disorder (7.5%), (6.4%) of them were COPD.
•Preoperative ABGs were mainly alkalotic and hypocapnic. Respiratory alkalosis associated with liver disease resolved after successful transplant, pH significantly decreased after operation (7.5±0.1 versus 7.4±0.1).
•A greater frequency of alveolar- arterial oxygen difference than hypoxemia (88.9%, 5.6%) respectively was recorded.
•Preoperative calculated mean pulmonary artery pressure was Mean±SD 34.2±5.7 by TTE.
•The most common abnormal radiological findings in preoperative chest CT present was pleural effusion (16.7%) of cases, presented commonly as right sided only, aspiration was done to 10.7% of cases revealing transudative effusion in 96% of them.
•The mean surgery duration was 10.7±1.4 hours, with a mean length of stay in the intensive care unit was 6.2±4.2days, and the mean total length of stay in the hospital was 29.1±12.1days.
•Pleural effusion was noted as the most common disorder on early postoperative chest radiographs, detected in 40.8% of patients. Pleural effusion was usually located in the right side (32.7%). Aspiration was done in 9% of them, all were transudative in nature and complicated by iatrogenic pneumothorax in (33%) of those tapped patients.
•Preoperative effusion and prothrombin time (PT) were significantly more frequent in cases with postoperative effusion than cases without postoperative effusion (24.2% versus 12.2% and 20.9±6.0 versus 19.5±4.5) respectively.
•Post liver transplant lower respiratory tract infections were noted in 22.7% of studied population with pneumonia in 8.9% of them. It was commonly caused by bacterial infection mainly Gram-negative organisms (70%). while gram-positive organisms, Fungal infection and viral infection constitutes (18.2%, 10.4%, 1.3%) respectively
•Diabetes mellitus, preoperative hyponatremia, postoperative thrombocytopenia, blood transfusion requirement, intraoperative bleeding and portal vein thrombosis were significantly higher in cases with postoperative pneumonia than cases without postoperative pneumonia.
•There were no significant differences in age, body mass index, preoperative echocardiography parameters, duration of surgery, MELD score and preoperative spirometry between patients who did or did not develop pneumonia after LT.
•Preoperative impaired renal function MELD, Child scores and intraoperative bleeding were significantly higher in patients with PRF than in those without PRF.
•Pleural effusion, postoperative respiratory failure and lower respiratory tract infections are the most frequently seen post liver transplantation pulmonary complications (40%, 23.5%, 22.7%) respectively.
•There were no significant differences between mortality and age, history of smoking, Child-Pugh score and results of pulmonary function tests.
•Diabetes mellitus, systolic pulmonary artery pressure, surgery duration, postoperative effusion, postoperative consolidation and postoperative thoracentesis were significantly higher and longer in non-survived than survived cases.
•Requirement for mechanical ventilation, delayed entral feeding, higher SOFA score, occurrence of PRF and pneumonia were significantly more frequent in non-survived cases.
•Post LT pulmonary complications occurred in 64.4% of LDLT recipients and were a cause of death in 16% of deaths, with pneumonia only 10.8%.
•Development of postoperative pulmonary complications were associated with higher early mortality, longer ICU stay and total hospital stay after surgery.
•Development of PRF was associated with significantly higher ICU stay after surgery, total hospital stay, early mortality and late mortality.
from the present study it was concluded that:
•Pulmonary disorders were common among LT candidates. These disorders included restrictive pattern of spirometry, alkalotic hypocapnic ABGs, widened alveolar-arterial oxygen difference and pleural effusion were the commonly noted pre-transplant pulmonary dysfunction and diseases among liver transplant candidates (59.8%, 61.1%, 88.9%, 16.7%) respectively.
•Post LT pulmonary dysfunction and diseases included post LT pulmonary complications, which frequently included pleural effusion, PRF and lower respiratory tract infections (40.1%, 23.5%, 22.7%) respectively.
•Post LT pulmonary complications were a cause of death in 16% of deaths, with pneumonia only 10.8%.
•Advanced liver condition, associated other system affection (DM, impaired renal function and hyponatremia), operative complications and requirement of blood transfusion were associated with higher incidence of PPCs.
•Postoperative pulmonary complications were associated with higher early mortality, longer ICU stay and total hospital stay after surgery.
•PRF was associated with significantly higher early mortality, late mortality longer ICU stay and total hospital stay after surgery.