Postoperative pulmonary complications after liver transplantation assessment of risk factors for mortality

Abstract

Background. The aim of this study was to identify the risk factors related to mortality in liver transplant (LT) patients with post-transplantation pulmonary complications. Method. Patients who underwent liver transplantation in our clinic between January 2010 and January 2012 were retrospectively reviewed for post-transplantation pulmonary complications. Demographic, clinical, radiologic, and postoperative chart data of 153 patients with pulmonary complications were analyzed using an independent samples Student t test, Pearson’s c2 test, Fisher’s exact test, and Yate’s corrected c2 test. Mortality was analyzed using a multiple logistic regression model. The best-fit breakpoint resulting in a cut-off value for the variables of interest was determined using ROC curves and the Youden index. Results. The 153 patients with pulmonary complication were divided into 2 groups: mortality (n ¼ 53) and survival (n ¼ 100). Univariate analyses showed significant differences between these 2 groups with respect to MELD score (P ¼ .035), duration of mechanical ventilation (P > .001), pneumonia (P ¼ .01), and endotracheal culture results (P ¼ .001). In the multivariate analysis, hemoglobin (P ¼ .03, odds ratio [OR]: 1.239), MELD score (P ¼ .027, OR: 1.064), duration of mechanical ventilation (P ¼ .003, OR: 1.091), and age (P ¼ .042, OR: 1.001) were significant risk factors for mortality. The best-fit breakpoint analysis yielded cut-off values for hemoglobin (>11.2, sensitivity: 50.9%, specificity: 70%), MELD score (>16, sensitivity: 73.6%, specificity: 42%) and duration of mechanical ventilation (>3, sensitivity: 62.3%, specificity: 76%). Conclusion. Advanced age, high hemoglobin level, high MELD score, and long-term mechanical ventilation are significant risk factors for mortality in liver transplant patients with postoperative pulmonary complications.