Title : Factors associated with early respiratory complications in the postoperative period of a patient with liver transplantation

Liver transplantation is the standard treatment for end-stage liver disease, but it may present respiratory complications in the postoperative period that impact patient survival. The objective of this study was to determine the factors associated with early respiratory complications and to assess their severity using the Clavien-Dindo classifications and the Comprehensive Complication Index. An observational, analytical, and retrospective study was conducted in 206 liver transplant recipients admitted to the Intensive Care Unit of the Center for Medical-Surgical Research for the early postoperative period, between 1999 and 2019. The variables evaluated included: age, sex, prognostic scores (MELD and Child-Pugh), pre-transplant diagnosis, fluids and blood products administered, time of artificial mechanical ventilation, stay in intensive care, and severity classifications. 32.1% of patients developed respiratory complications, predominantly pneumonia (39.50%), pleural effusion (23.45%), and acute respiratory distress syndrome (12.34%). By multivariate analysis, the following factors were identified independently associated with these complications: autoimmune cirrhosis (OR: 33.76), cholestatic autoimmune cirrhosis (OR: 12.61), viral cirrhosis (OR: 4.66), enole cirrhosis (OR: 4.71), mechanical ventilation time greater than 3 days (OR: 42.89) and ICU stay greater than 7 days (OR: 3.15). These complications were classified as serious according to Clavien-Dindo ≥ III and a high Comprehensive Complication Index. It is concluded that pneumonia was the main respiratory complication, while the types of cirrhosis mentioned, prolonged mechanical ventilation and prolonged ICU stay emerge as independent risk factors associated with serious respiratory complications in the early postoperative period of liver transplantation.

Dr. Francisco Gómez Peire is a specialist in Adult Intensive Care, he recently completed a PhD on the postoperative period of liver transplantation and postoperative respiratory complications. This topic has been his main line of research in recent years, participating in scientific events and making publications. He currently works in the intensive care unit of the Center for Surgical Medical Research (CIMEQ) in Havana, Cuba, is a professor and researcher and is a member of the scientific society of intensive care of Cuba.