Pulmonary complications of liver transplantation: radiological appearance and statistical evaluation of risk factors in 300 cases

The aim of this study was to evaluate the incidence radiographic appearance , time of onset, outcome and risk factors of non-infectious and infectious pulmonary complications following liver transplantation. Chest X-ray featur es of 300 consecutive patients who had undergone 333 liver transplants over an 11-year period were analysed: the type of pulmonary complication, the i nfecting pathogens and the mean of their occurrence are described. The main factors for lung infections were quantified univariate and multivariate st atistical analysis. Non-infectious pulmonary abnormalities (atelectasis and /or pleural effusion: 86.7%) and pulmonary oedema (44.7%) appeared during t he first postoperative week. Infectious pneumonia was observed in 13.7%, wi th a mortality of 36.6%. Bacterial and viral pneumonia made up the bulk of infections (63.4 and 29.3%, respectively) followed by fungal infiltrates (2 4.4%). A fairly good correlation between radiological chest X-ray pattern, time of onset and the cultured microorganisms has been observed in all case s. In multivariate analysis, persistent non-infectious abnormalities and pu lmonary oedema were identified as the major independent predictors of postt ransplant pneumonia, followed by prolonged assisted mechanical ventilation and traditional caval anastomosis. A "pneumonia-risk score" was calculated low-risk score ( < 2.25) predicts 2.7% of probability of the onset of infec tions compared with 28.7% of risk (> 3.30) population. The "pneumonia-risk" identifies a specific group of patients in whom closer radiographic monito ring is recommended. In addition, a highly significant correlation (p < 0.0 01) was observed between pneumonia-risk score and the expected survival, th us confirming pulmonary infections as a major cause of death of OLT recipie nts.