Preemptive thoracic drainage to eradicate postoperative pulmonary complications after living donor liver transplantation

Daisuke Imai, Toru Ikegami, Takeo Toshima, Tomoharu Yoshizumi, Yo Ichi Yamashita, Mizuki Ninomiya, Norifumi Harimoto, Shinji Itoh, Hideaki Uchiyama, Ken Shirabe, Yoshihiko Maehara

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1134-1142.e2
JournalJournal of the American College of Surgeons
Volume219
Issue number6
DOIs
Publication statusPublished - 2014

All Science Journal Classification (ASJC) codes

  • Surgery

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