Preoperative DLCO predicts severe early complications after liver transplantation

Xing Li; Louise Barbier; Martine Ferrandière; Francis Remerand; Ephrem Salamé; Laurent Plantier

doi:10.1016/j.resmer.2024.101089

Preoperative DLCO predicts severe early complications after liver transplantation

Respir Med Res. 2024 Feb 7:85:101089. doi: 10.1016/j.resmer.2024.101089. Online ahead of print.

Authors

Xing Li¹, Louise Barbier², Martine Ferrandière³, Francis Remerand³, Ephrem Salamé², Laurent Plantier⁴

Affiliations

¹ Department of Pulmonology and Pulmonary Function Testing, University Hospital of Tours, France. Electronic address: xing.li@chu-lille.fr.
² Department of Digestive Surgery and Liver Transplantation, University Hospital of Tours, France; INSERM U1082, Poitiers, France; FHU SUPPORT, Tours-Poitiers-Limoges, France; University of Tours, Tours, France.
³ Surgical Intensive Care Unit, University Hospital of Tours, Tours, France.
⁴ Department of Pulmonology and Pulmonary Function Testing, University Hospital of Tours, France; University of Tours, Tours, France; CEPR, Inserm UMR1100, Tours, France.

PMID: 38657299
DOI: 10.1016/j.resmer.2024.101089

Abstract

Background: Severe early complications are common after liver transplantation (LT) and are a key determinant of LT-related morbidity and mortality. The aim of this study was to assess whether lung function measured in the pre-operative period predicted complicated outcomes in the first month after LT.

Material and methods: Patients with mild-to-moderate liver disease (Model for End stage Liver Disease-MELD score≤30) who underwent LT between October 2015 and May 2020 in a single centre were retrospectively included. The primary endpoint was the occurrence of severe early complications after LT defined by mechanical ventilation duration > 2 days or length of ICU stay > 7 days or reintubation or death < 1 month after LT.

Results: One hundred and twenty patients were included (age 59 [53-64] years, 72 % men). Forty patients (33 %) had early complications after LT. Measured and%predicted hemoglobin-corrected lung transfer capacity for carbon monoxide (DLCOc) were significantly lower in patients with severe early complications after LT. DLCOc was the only variable that associated independently with severe early complications by multivariate analysis. DLCOc under 16.3 ml.min^-1.mmHg^-1 predicted respiratory complications with a sensitivity of 67.5 % and a specificity of 62.9 %. DLCOc%pred under 61.5 % had a sensitivity of 56.8 % and a specificity of 72 %. DLCOc independently associated with forced vital capacity (FVC), pulmonary emphysema, and the muscle mass index.

Conclusion: A decrease in DLCOc indicated an increased risk of severe early complications after LT.

Keywords: DLCO; Liver transplantation; Pulmonary function test.