Impact of postoperative pulmonary complications on clinical outcomes in liver transplantation: a single-center retrospective analysis

Abstract Background Liver transplantation (LT) is the definitive treatment for end-stage liver disease. However, postoperative pulmonary complications (PPCs) significantly contribute to morbidity and mortality. This study aims to analyze the incidence, risk factors, and clinical impact of PPCs in adult LT recipients. Methods We retrospectively analyzed 86 adult patients who underwent LT at our tertiary referral center. Patients were categorized based on the development of PPCs, including pleural effusion, atelectasis, ARDS, pneumonia, and the need for reintubation. Demographic data, perioperative variables, and clinical outcomes (ICU stay, hospital stay, and 30-day mortality) were compared. Results The overall incidence of postoperative pulmonary complications (PPCs) was 46.5%. Atelectasis (32.6%) and reintubation (22.1%) were the most frequent complications. Patients who developed PPCs had significantly longer ICU stays (11.0 vs. 4.0 days, p < 0.001) and hospital stays (19.5 vs. 16.5 days, p = 0.045). In adjusted analysis using negative binomial regression, PPCs were independently associated with prolonged ICU length of stay (IRR 2.41, 95% CI 1.78–3.26, p < 0.001). Smoking exposure was significantly associated with PPC development and remained the only independent predictor in multivariable analysis (adjusted OR 1.38 per 10 pack-years, 95% CI 1.08–1.82, p = 0.021). The overall 30-day mortality rate was 19.8%. Mortality occurred more frequently among patients with PPCs (25.0% vs. 15.2%), although this difference did not reach statistical significance. Conclusion PPCs are highly prevalent after LT and are associated with prolonged resource utilization. Smoking is a modifiable risk factor that predicts PPCs. Early identification and aggressive perioperative respiratory management are crucial to improving outcomes in LT recipients.