Patterns of perioperative thoracic fluid indices changes in liver transplantation with or without postoperative acute lung injury

Abstract

Background/purpose: Postoperative acute lung injury (ALI) after liver transplantation is clinically relevant and common. The perioperative thoracic fluid indices changes as well as the association with ALI in liver transplantation have not been thoroughly investigated.

Methods: A total of 52 consecutive adult recipients for elective living donor liver transplantation were enrolled. Each recipient received the same perioperative care plan. Thoracic fluid indices, including the cardiac index, intrathoracic blood volume index (ITBVI), extravascular lung water index (EVLWI), and pulmonary vascular permeability index (PVPI), were obtained at seven time points (pretransplantation, anhepatic phase, 30 minutes after reperfusion, 2 hours after reperfusion, and postoperative days 1-3) using the pulse contour cardiac output system. The indices of those who developed ALI (PaO₂/FiO₂ < 300 mmHg with lung infiltrates on chest X-ray) were compared with the indices of those who did not.

Results: Recipients who developed postoperative ALI had longer mechanical ventilation duration and had a higher model for end-stage liver disease score, required more platelet transfusion, and were higher in pretransplant EVLWI and PVPI level. During the anhepatic phase, ITBVI, central venous pressure, cardiac index, and EVLWI decreased and PVPI increased. After transplantation, ITBVI increased above pretransplant status, while EVLWI and PVPI were comparable in both groups.

Conclusion: Recipients who did or did not develop ALI after liver transplantation had a longer mechanical ventilation duration and showed different patterns of perioperative thoracic fluid indices, especially in the pretransplant status of PVPI level. Knowledge of these perioperative changes may provide clinicians with helpful information to make postoperative care choices.

Keywords: acute lung injury; liver transplantation; postoperative pulmonary complications; pulmonary vascular permeability; transpulmonary thermodilution.