Risk factors associated pneumonia in post operative early liver transplant

Abstract

Purpose: To identify the main risk factors related to pneumonia in early pre-liver transplant surgery. Methods: A control case study performed from June to December of 2014 with patients submitted to liver transplant in a medical teaching hospital in Fortaleza, state of Ceará. It was included in the study patients of both genders submitted to liver transplant, and those presenting insufficient data in their medical records which would damage the analysis of data, those who died until the 5th post-surgery day, and those who were submitted to re-transplant due to primary dysfunction of the graft were excluded. The data collection was performed from June to December of 2014 by prospective analysis of the records from every patient submitted to liver transplant during that period. The records were analyzed in the pre, trans-, and post-surgery periods up to their hospital discharge. Results: The sampling was composed by 52 patients being 69.2% male with average age of 55 years ( 12.5). Different etiologies were found from which the most predominant were viral hepatitis (51.9%) and alcoholic cirrhosis (21.1%). Participants in the sampling presented an average MELD score of 22 ( 4.8). The potential risk factors to develop early pneumonia in the liver post-transplantation by bivariate analysis include age (p= 0.09), pre-surgery MELD (p= 0.22), pre-hospitalization to the surgery (p= 0.09), time of cold ischemia (p=0.22), and time of mechanical ventilation (p= 0.08). In the multivariate analysis, the independent risk factors were higher time in intensive care unit (p=0.002), need for reintubation (p= 0.002), and use of a prophylactic antibiotic other than Ampicilin + Sulbactam (routine prophylactic antibiotic in the service) (p= 0.02). Conclusion: Pneumonia is a frequent pulmonary complication with a high mortality rate in the early liver post-transplant period. Such complication can be associated with several pre-, trans- and post-surgery factors.