Postoperative Trapped Lung After Orthotopic Liver Transplantation is a Predictor of Increased Mortality

Natasha Cuk; Kathryn H Melamed; Sitaram Vangala; Ramy Salah; W Dwight Miller; Sarah Swanson; David Dai; Zarah Antongiorgi; Tisha Wang; Vatche G Agopian; Joseph Dinorcia; Douglas G Farmer; Jane Yanagawa; Fady M Kaldas; Igor Barjaktarevic

doi:10.3389/ti.2022.10387

Postoperative Trapped Lung After Orthotopic Liver Transplantation is a Predictor of Increased Mortality

Transpl Int. 2022 May 3:35:10387. doi: 10.3389/ti.2022.10387. eCollection 2022.

Authors

Affiliations

¹ Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
² Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
³ Clinical and Translational Science Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
⁴ Division of Critical Care Medicine, Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
⁵ Division of Transplant Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
⁶ Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.

Abstract

Pleural effusions are a common complication of orthotopic liver transplantation (OLT), and chronic post-OLT pleural effusions have been associated with worse outcomes. Furthermore, "trapped lung" (TL), defined as a restrictive fibrous visceral pleural peel preventing lung re-expansion, may have prognostic significance. We performed a retrospective analysis of adult OLT recipients over a 9-year period at UCLA Medical Center. Post-OLT patients with persistent pleural effusions, defined by the presence of pleural fluid requiring drainage one to 12 months after OLT, were included for analysis. Outcomes for patients with and without TL were compared using univariate and multivariate analysis. Of the 1722 patients who underwent OLT, 117 (7%) patients met our criteria for persistent postoperative pleural effusion, and the incidence of TL was 21.4% (25/117). Compared to patients without TL, those with TL required more surgical pleural procedures (OR 59.8, 95%CI 19.7-181.4, p < 0.001), spent more days in the hospital (IRR 1.56, 95%CI 1.09-2.23, p = 0.015), and had a higher risk of mortality (HR 2.47, 95%CI 1.59-3.82, p < 0.001) following transplant. In sum, we found that post-OLT TL was associated with higher morbidity, mortality, and healthcare utilization. Future prospective investigation is warranted to further clarify the risk factors for developing postoperative pleural effusions and TL.

Keywords: hepatic hydrothorax; liver transplantation; pleural effusions; pneumothorax-ex-vacuo; trapped lung.

MeSH terms

Adult
Disease Progression
Humans
Liver Transplantation* / adverse effects
Lung
Pleural Effusion* / etiology
Pleural Effusion* / surgery
Pneumonia* / complications
Retrospective Studies
Risk Factors