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Predictive Value of Preoperative Pulmonary Function Tests and Model for End Stage Liver Disease (MELD) Score for Postoperative Pulmonary Complications in Liver Transplantation Patients FREE TO VIEW

Dina Khateeb; Marc Lavietes; Baburao Koneru; Zeeshan Khan; Narjust Perez-Florez; Andrew Berman
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Rutgers-New Jersey Medical School, Newark, NJ

Chest. 2014;146(4_MeetingAbstracts):805A. doi:10.1378/chest.1994366
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SESSION TITLE: Physiology/PFTs/Rehabilitation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Pulmonary disorders are common in patients with end stage liver disease (ESLD). Postoperative pulmonary complications occur frequently in patients undergoing upper abdominal surgeries. Preoperative pulmonary evaluation is essential for candidates for Liver Transplantation (LT). The predictive value of Pulmonary Function Tests (PFTs) and MELD score for postoperative pulmonary complications in this population is unclear. We sought to test the hypothesis that PFTs and MELD score predict postoperative morbidity and mortality in LT candidates.

METHODS: This was a retrospective study of 81 LT performed during the years of 1995-1999. Linear regression analyses were performed using independent variables (MELD and PFTs), and dependent variables (postoperative atelectasis, pneumonia, respiratory failure, duration of mechanical ventilation [MV], length of stay [LOS], and mortality at 30 and 90 days and at one year).

RESULTS: Patients were predominantly male (64%). 64% had ESLD secondary to alcohol or hepatitis C. 61.7% were current or former smokers. The mean MELD score was 17.8. Pneumonia occurred in 7.4%, 42% had atelectasis, 12.3% developed respiratory failure, and 22.2% required more than one day of MV postoperatively. There were no mortalities within 30 days, two within 90 days, and three within one year. Preoperative PFTs (FVC, FEV1, FEV1/FVC, FEF 25%-75%, TLC, FRC, RV, DLCO) did not significantly predict the occurrence of any postoperative pulmonary complication, days of MV, LOS, or mortality. An inverse relationship between MELD and DLCO was significant (p=0.05). MELD was a significant predictor of pneumonia (p=0.03) and directly proportional to duration of MV (p=0.027).

CONCLUSIONS: There was no significant predictive value of preoperative PFTs in post LT morbidity and mortality. The inverse relationship between the MELD and DLCO is consistent with previous reports, and suggests gas exchange abnormalities in LT candidates. The MELD score may predict post-operative pulmonary complications.

CLINICAL IMPLICATIONS: Routine preoperative PFTs may not be warranted for all LT patients. High MELD scores should alert the LT team for possible increased risk of postoperative pulmonary complications.

DISCLOSURE: The following authors have nothing to disclose: Dina Khateeb, Marc Lavietes, Baburao Koneru, Zeeshan Khan, Narjust Perez-Florez, Andrew Berman

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