Ravshan Aliyevich Ibadov, Sardor Khamdamovich Ibragimov
Experimental and Clinical Transplantation - 2025;23(11):713-719
Objectives: Acute respiratory distress syndrome remains a serious multifactorial complication after liver transplant, characterized by high mortality. Key determinants and risk factors for acute respiratory distress syndrome remain incompletely understood. Materials and Methods: We retrospectively investigated risk factors for acute respiratory distress syndrome in 124 patients after living donor liver transplant between January 2018 and March 2025. We analyzed preoperative clinical information, intraoperative course characteristics, and patient parameters on admission to the intensive care unit after surgery, as well as complications and outcomes. Acute respiratory distress syndrome was diagnosed in accordance with the Berlin definition as the presence of acute hypoxemia, bilateral pulmonary infiltrates on chest radiography consistent with pulmonary edema, and respiratory failure not fully explained by cardiac dysfunction or fluid overload. We conducted multivariate logistic regression analysis to differentiate risk factors. Results: Among the 124 analyzed patients, 16 (12.9%) were diagnosed with acute respiratory distress syndrome, predominantly within the first 24 hours. Preoperative presence of hepatopulmonary syndrome (odds ratio 6.86; P < .001), intraoperative high total red blood cell transfusion volume (odds ratio 1.90; P = .011), postoperative elevated white blood cell count (odds ratio 1.56; P = .020), neutrophil-to-lymphocyte ratio (odds ratio 2.00; P = .03), decreased Pao 2 (odds ratio 0.93; P = .010), lower international normalized ratio (odds ratio 0.004; P = .027), total bilirubin concentration (odds ratio 1.01; P = .030), and serum albumin level (odds ratio 1.12; P = .006) were risk factors. Patients also experienced significantly higher rates of early postoperative complications, systemic disorders, prolonged mechanical ventilation and hospitalization, and hospital mortality (25%; P < .001). Conclusions: Acute respiratory distress syndrome after living donor liver transplant was associated with hepato-pulmonary syndrome, intraoperative large-volume red blood cell transfusion, postoperative white blood cells, neutrophil-to-lymphocyte ratio, Pao 2, international normalized ratio, albumin, and total bilirubin.
