Preemptive Thoracic Drainage to Eradicate Postoperative Pulmonary Complications after Living Donor Liver Transplantation - 18/11/14
, Takeo Toshima, MD, Tomoharu Yoshizumi, MD, FACS, Yo-ichi Yamashita, MD, Mizuki Ninomiya, MD, Norifumi Harimoto, MD, Shinji Itoh, MD, Hideaki Uchiyama, MD, FACS, Ken Shirabe, MD, PhD, Yoshihiko Maehara, MD, PhD, FACSAbstract |
Background |
Thoracic fluid retention after living donor liver transplantation (LDLT) has various negative consequences, including atelectasis, pneumonia, and respiratory distress or failure.
Study design |
We analyzed the clinical impact of preemptive thoracic drainage in 177 patients undergoing adult-to-adult LDLT for chronic liver diseases at a single center. Recipients were divided into 2 time periods. The earlier cohort (n = 120) was analyzed for risk factors for postoperative atelectasis retrospectively; the later cohort (n = 57), with a risk factor for postoperative atelectasis, underwent preemptive thoracic drainage prospectively. The incidence of postoperative pulmonary complications was compared between these 2 cohorts.
Results |
Independent risk factors for atelectasis in earlier cohort were body mass index ≥27 kg/m2 (p < 0.001), performance status ≥3 (p = 0.003) and model for end-stage liver disease score ≥23 (p = 0.005). The rates of atelectasis (21.1% vs 42.5%, p = 0.005) and pneumonia (1.8% vs 10.0%, p = 0.049) were significantly lower in later than in earlier cohort. Moreover, the mean durations of ICU stay (3.6 ± 0.2 days vs 5.7 ± 0.6 days, p = 0.038) and postoperative oxygen support (5.1 ± 0.8 days vs 7.1 ± 0.5 days, p = 0.037) were significantly shorter in the later than in the earlier cohort. There were no significant differences in the incidence of adverse events associated with thoracic drainages between these 2 cohorts.
Conclusions |
Preemptive thoracic drainage for transplant recipients at high risk of postoperative atelectasis could decrease morbidities after LDLT.
Le texte complet de cet article est disponible en PDF.Abbreviations and Acronyms : AUC, DDLT, FiO2, LDLT, MELD, OR, PaO2, POD
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Vol 219 - N° 6
P. 1134 - décembre 2014 Retour au numéro
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