Acute Respiratory Failure and Pulmonary Complications in End-Stage Liver Disease

Nida Qadir, MD; Tisha Wang, MD; Igor Barjaktarevic, MD, PhD; Steven Y. Chang, MD, PhD


Semin Respir Crit Care Med. 2018;39(5):546-555. 

In This Article

Impact of IMV on Transplant Candidacy

Although the combination of ESLD and acute respiratory failure is associated with high mortality, individuals who survive to transplant have acceptable long-term outcomes. Patients with preoperative mechanical ventilation are more likely to have postoperative respiratory failure and prolonged ICU length of stay,[121,122] but demonstrate no significant difference in long-term mortality and graft survival compared with patients without preoperative respiratory failure.[122,123] However, the role of severity and duration of respiratory failure in transplant outcomes have not been well studied. Linecker et al recently proposed a list of "absolute" and "relative" contraindications not usually captured in risk scores where early posttransplant mortality is highly probable and liver transplant may be inappropriate. Severe hypoxemia (requirement of FiO2 ≥ 0.8) was included as an absolute contraindication on this list. Complications of prolonged mechanical ventilation, including aggregated severe chronic comorbidities and severe frailty due to muscle wasting were included as relative contraindications as well.[124] In summary, while IMV should not be considered a contraindication to transplant, a cautious approach should be utilized when evaluating patients with severe or prolonged respiratory failure with complications.