• Fluid therapy
• Liver transplantation
• Living donors
• Pediatric intensive care unit
• Postoperative management

• Factor
• Graft-to-recipient weight ratio
• Liver transplantation
• Pediatric
• Systemic inflammatory response syndrome

• Humans
• Liver Transplantation/adverse effects
• Systemic Inflammatory Response Syndrome/etiology
• Male
• Female
• Retrospective Studies
• Child
• Child, Preschool
• Risk Factors
• Infant
• Postoperative Complications/etiology
• Organ Size
• Adolescent
• ROC Curve
• Body Weight
• Multivariate Analysis

• Fluid administration
• Intraoperation
• Living donor liver transplantation
• Outcomes
• Pediatric

• Humans
• Liver Transplantation
• Living Donors
• Male
• Female
• Fluid Therapy/methods
• Retrospective Studies
• Child, Preschool
• Child
• Intraoperative Care/methods
• Infant
• Treatment Outcome
• Blood Loss, Surgical/statistics & numerical data
• Length of Stay/statistics & numerical data
• Adolescent

• NCRCCHD-2022-GP-14 National Clinical Research Center for Child Health and Disorders

• Humans
• Liver Transplantation
• Male
• Female
• Middle Aged
• Retrospective Studies
• Crystalloid Solutions/administration & dosage
• Crystalloid Solutions/therapeutic use
• Albumins/administration & dosage
• Albumins/therapeutic use
• Adult
• Fluid Therapy
• Isotonic Solutions/administration & dosage
• Treatment Outcome

• Feature importance
• Liver transplantation
• Prediction of complications
• Transfer learning

• Humans
• Liver Transplantation/adverse effects
• Diagnosis, Computer-Assisted
• Machine Learning
• Postoperative Complications
• Computers

• 52078212 National Natural Science Foundation of China
• ZYLX201822 Key Medical Professional Development Plan of Beijing Municipal Hospital Administration
• IWHR-SKL-202003 State Key Laboratory of Simulation and Regulation of Water Cycle in River Basin, China Institute of Water Resources and Hydropower Research

• high MELD
• liver transplant
• living donor
• living donor liver transplant (LDLT)

• Light’s criteria
• exudative pleural effusion
• hepatic hydrothorax
• orthotopic liver transplantation

• Aging
• Assessment
• Follow-up
• Marginal organs
• Prehabilitation

Liver transplantation is a major abdominal operation and the intimate anatomic relation of the liver with the right hemidiaphragm predisposes the patient to various manifestations in the chest cavity. Furthermore, chronic liver disease affects pulmonary function before and after liver transplantation resulting in a considerable percentage of patients presenting with morbidity related to chest complications. This review aims to identify the potential chest complications of surgical interest during or after liver transplantation. Complications of surgical interest are defined as those conditions that necessitate an invasive procedure (such as thoracocentesis or a chest tube placement) in the chest or a surgical intervention performed by a thoracic surgeon. These complications will be classified as perioperative and postoperative; the latter will be categorized as early and late. Although thoracocentesis or a chest tube placement is usually sufficient when invasive measures are deemed necessary, in some patients, thoracic surgical interventions are warranted. A high index of suspicion is needed to recognize and treat these conditions promptly. A close collaboration between abdominal surgeons, intensive care unit physicians and thoracic surgeons is of paramount importance.

• Surgical chest complications
• Liver transplantation
• Chest related morbidity
• Multidisciplinary treatment
• Surgery

Acute lung injury (ALI) after liver transplantation (LT) may lead to acute respiratory distress syndrome, which is associated with adverse postoperative outcomes, such as prolonged hospital stay, high morbidity, and mortality. Therefore, it is vital to maintain hemodynamic stability and optimize fluid management. However, few studies have reported cardiac output-guided (CO-G) management in pediatric LT.

To investigate the effect of CO-G hemodynamic management on early postoperative ALI and hemodynamic stability during pediatric living donor LT.

A total of 130 pediatric patients scheduled for elective living donor LT were enrolled as study participants and were assigned to the control group (65 cases) and CO-G group (65 cases). In the CO-G group, CO was considered the target for hemodynamic management. In the control group, hemodynamic management was based on usual perioperative care guided by central venous pressure, continuous invasive arterial pressure, urinary volume, etc. The primary outcome was early postoperative ALI. Secondary outcomes included other early postoperative pulmonary complications, readmission to the intense care unit (ICU) for pulmonary complications, ICU stay, hospital stay, and in-hospital mortality.

The incidence of early postoperative ALI was 27.7% in the CO-G group, which was significantly lower than that in the control group (44.6%) (P < 0.05). During the surgery, the incidence of postreperfusion syndrome was lower in the CO-G group (P < 0.05). The level of intraoperative positive fluid transfusions was lower and the rate of dobutamine use before portal vein opening was higher, while the usage and dosage of epinephrine during portal vein opening and vasoactive inotropic score after portal vein opening were lower in the CO-G group (P < 0.05). Compared to the control group, serum inflammatory factors (interleukin-6 and tumor necrosis factor-α), cardiac troponin I, and N-terminal pro-brain natriuretic peptide were lower in the CO-G group after the operation (P < 0.05).

CO-G hemodynamic management in pediatric living-donor LT decreases the incidence of early postoperative ALI due to hemodynamic stability through optimized fluid management and appropriate administration of vasopressors and inotropes.

• Cardiac output
• Hemodynamic management
• Child
• Liver transplantation
• Acute lung injury
• Reperfusion injury

• 25-hydroxyvitamin D3
• pediatric living donor liver transplantation
• pulmonary infections

• liver transplant
• outcomes
• pulmonary function tests

• ICU outcomes
• critical care
• pulmonary complications

This study was designed to observe incidence and risk factors of low oxygenation after orthotropic liver transplantation (OLT).

We retrospectively evaluated all adult patients who underwent living-donor OLT between January 1, 2017 and December 31, 2017. Postoperative low oxygenation was defined as PaO₂/FiO₂ <300 mmHg within 24 hours after surgery. Early acute kidney injury (AKI) after OLT was also defined when AKI was happened with 24 hours after operative.

A total of 301 patients, aged 50.35±10.29 years were enrolled. Of these patients, 100 patients (33.2%) suffered postoperative low oxygenation (PaO₂/FiO₂=251.80±35.84). Compared with the normal oxygenation group, body mass index (BMI) (24.48±3.53 versus 23.1±3.27 kg/m², P=0.001), preoperative hemoglobin (115.79±29.27 versus 111.52±29.80 g/L, P=0.033), preoperative MELD (22.25±6.54 versus 20.24±5.74, P=0.008), and intraoperative urinary volume (1.25 [0.76, 1.89] versus 2.04 [1.49, 3.68] mL/kg/h, P=0.003) were higher in low oxygenation group. There were more cases of earlier AKIs that occurred after OLT in low oxygenation patients than that in normal group (47% versus 23.4%, P<0.001). Logistic analysis showed that the preoperative BMI (hazard ration [HR]=1.107, [1.010, 1.212], P=0.029) and early AKI after OLT (HR=2.115, [1.161, 3.855], P=0.014) were independent risk factors for postoperative low oxygenation.

The incidence of postoperative low oxygenation after liver transplantation in adults was 33.2%. BMI and early AKI after OLT were correlated with postoperative hypoxemia.

• atelectasis
• intensive care
• liver transplantation
• pleural effusions
• pneumonia
• pulmonary complications
• pulmonary edema
• risk factors

• Critical Care
• Humans
• Kidney Failure, Chronic/surgery
• Liver Transplantation/adverse effects
• Lung Diseases/diagnosis
• Lung Diseases/therapy
• Pleural Effusion/diagnosis
• Pleural Effusion/therapy
• Pneumonia/diagnosis
• Pneumonia/therapy
• Postoperative Complications/diagnosis
• Postoperative Complications/therapy
• Preoperative Care
• Pulmonary Atelectasis/diagnosis
• Pulmonary Atelectasis/therapy
• Pulmonary Edema/diagnosis
• Pulmonary Edema/therapy
• Risk Factors

• Complications
• Fluid administration
• Fluid management
• Fluid resuscitation
• Goal-directed therapy
• Liberal fluid
• Liver transplantation
• Phlebotomy
• Restrictive fluid

Whereas continuous renal replacement therapy (CRRT) has been utilized during liver transplantation (LT), there was a lack of evidence to support this practice. We investigated the adverse events at the perioperative periods in recipients of LT who received preoperative CRRT without intraoperative CRRT.

We retrospectively reviewed medical records of adult patients (age ≥ 18 years) who received LT between December 2009 and May 2015. Perioperative data were collected from the recipients, who received preoperative CRRT until immediately before LT, because of refractory renal dysfunction.

Of 706 recipients, 42 recipients received preoperative CRRT. The mean (standard deviation) Model for end-stage liver disease score were 49.6 (13.4). Twenty-six point two percent (26.2%) of recipients experienced the serum potassium > 4.5 mEq/L before reperfusion and treated with regular insulin. Thirty-eight point one percent (38.1%) of recipients were managed with sodium bicarbonate because of acidosis (base excess < −10 mEq/L throughout LT). All patients finished their operations without medically uncontrolled complications such as severe hyperkalemia (serum potassium > 5.5 mEq/L), refractory acidosis, or critical arrhythmias. Mortality was 19% at 30 day and 33.3% at 1 year.

Although intraoperative CRRT was not used in recipients with severe preoperative renal dysfunction, LT was safely performed. Our experience raises a question about the need for intraoperative CRRT.

• Complications
• Liver transplantation
• Renal replacement therapy

To analyze whether fluid overload is an independent risk factor of adverse outcomes after liver transplantation (LT).

One hundred and twenty-one patients submitted to LT were retrospectively evaluated. Data regarding perioperative and postoperative variables previously associated with adverse outcomes after LT were reviewed. Cumulative fluid balance (FB) in the first 12 h and 4 d after surgery were compared with major adverse outcomes after LT.

Most of the patients were submitted to a liberal approach of fluid administration with a mean cumulative FB over 5 L and 10 L, respectively, in the first 12 h and 4 d after LT. Cumulative FB in 4 d was independently associated with occurrence of both AKI and requirement for renal replacement therapy (RRT) (OR = 2.3; 95%CI: 1.37-3.86, P = 0.02 and OR = 2.89; 95%CI: 1.52-5.49, P = 0.001 respectively). Other variables on multivariate analysis associated with AKI and RRT were, respectively, male sex and Acute Physiology and Chronic Health Disease Classification System (APACHE II) levels and sepsis or septic shock. Mortality was shown to be independently related to AST and APACHE II levels (OR = 2.35; 95%CI: 1.1-5.05, P = 0.02 and 2.63; 95%CI: 1.0-6.87, P = 0.04 respectively), probably reflecting the degree of graft dysfunction and severity of early postoperative course of LT. No effect of FB on mortality after LT was disclosed.

Cumulative positive FB over 4 d after LT is independently associated with the development of AKI and the requirement of RRT. Survival was not independently related to FB, but to surrogate markers of graft dysfunction and severity of postoperative course of LT.

• Liver transplantation
• Fluid balance
• Acute kidney injury

The poor clinical conditions associated with end-stage cirrhosis, pre-existing pulmonary abnormalities, and high comorbidity rates in patients with high Model for End-Stage Liver Disease scores are all well-recognized factors that increase the risk of pulmonary complications after orthotopic liver transplantation (OLT) surgery. Many intraoperative and postoperative events, such as fluid overload, massive transfusion of blood products, hemodynamic instability, unexpected coagulation abnormalities, renal dysfunction, and serious adverse effects of reperfusion syndrome, are other factors that predispose an individual to postoperative respiratory disorders. Despite advances in surgical techniques and anesthesiological management, the lung may still suffer throughout the perioperative period from various types of injury and ventilatory impairment, with different clinical outcomes. Pulmonary complications after OLT can be classified as infectious or non-infectious. Pleural effusion, atelectasis, pulmonary edema, respiratory distress syndrome, and pneumonia may contribute considerably to early morbidity and mortality in liver transplant patients. It is of paramount importance to accurately identify lung disorders because infectious pulmonary complications warrant speedy and aggressive treatment to prevent diffuse lung injury and the risk of evolution into multisystem organ failure. This review discusses the most common perioperative factors that predispose an individual to postoperative pulmonary complications and these complications’ early clinical manifestations after OLT and influence on patient outcome.

• Respiratory complications
• Postoperative respiratory failure
• Liver transplantation
• Postoperative edema
• Post-transplant pneumonia

• Humans
• Liver Transplantation/adverse effects
• Lung/physiopathology
• Lung Diseases/diagnosis
• Lung Diseases/etiology
• Lung Diseases/physiopathology
• Lung Diseases/therapy
• Prognosis
• Respiration
• Risk Factors
• Time Factors
• Treatment Outcome