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Objective: To study the etiology, prevention andmanagement of acute respiratory distress syndrome(ARDS) after liver transplantation.Methods: The clinical data of 104 patients with end-stage liver diseases who had had liver transplanta-tions were retrospectively reviewed.Results: Seventeen patients (16.3%, 17/104) alto-gether were diagnosed as having ARDS after livertransplantation. Ten of them developed ARDS within24 hours, of whom 1 died during the operation, and7 developed ARDS 3 or 4 days after they were extu-bated and when methylprednisolone was tapered.Fourteen of the 17 ARDS patients (14/17) werefound to have overloaded crystalloid infusion, mas-sive transfusion of blood or blood products such asplasma, platelets, in addition to a prolonged surgicaltime secondary to serious bleeding during the dis-eased liver removal without evidence of active infec-tion. One was found to have serious systemic infec-tion and operatively disseminated intravascular coag-ulation. Four of the recipients developed ARDS sud-denly when intravenous cyclosporine was given on the3rd day after operation. One patient of the 4 had allof the aforementioned conditions. Two patients suf-fered from gastric aspiration. Five (30%, 5/17) ofthem survived ARDS with the combined treatmentconsisting of positive end-expiratory pressure me-chanicai ventilation suctioning as much edema fluidor sputum as possible, administration of diuretics,bolus of corticosteroids, and culture-based antibiot-ics. Hemeodialysis was indicated for patients with ol-iguric renal failure.Conclusions: ARDS is a serious multifactoral compli-cation after liver transplantation with a high mortali-ty and fatality. The most likely cause is fluid over-load from crystalloid liquid infusion or massive trans-fusion. The other predisposing or contributing fac-tors include sepsis, Ⅳ use of cyclosporine, fast ta-pering of corticosteroids, and gastric aspiration.Other factors such as transfusion-related acute lunginjury (TRALI), and reperfusion syndrome of thenewly implanted liver may also contribute. Thoughthe treatment should primarily be supportive in na-ture, it is helpful to understand the predisposing andcontributing factors and to aid in prevention, man-agement and treatment.
Objective: To study the etiology, prevention and management of acute respiratory distress syndrome (ARDS) after liver transplantation. Methods: The clinical data of 104 patients with end-stage liver diseases who had had liver transplanta-tions were retrospectively reviewed. Results: Seventeen patients (16.3%, 17/104) alto-gether were diagnosed as having ARDS after livertransplantation. Ten of them developed ARDS within24 hours, of whom 1 died during the operation, and7 developed ARDS 3 or 4 days after they were extu-bated and when 14 (14/17) were found to have overloaded crystalloid infusion, mas-sive transfusion of blood or blood products such as plasma, platelets, in addition to a prolonged surgical time secondary to serious bleeding during the dis- eased liver removal without evidence of active infec tion. One was found to have serious systemic infecation and operatively disseminated intravascular coag-ulation. Four of the recipie nts developed ARDS sud-denly when intravenous cyclosporine was given on the 3rd day after operation. One patient of the 4 had all of the conditions conditions. Two patients suf-fered from gastric aspiration. Five (30%, 5/17) of the survivors ARDS with the combined treatmentconsisting of positive end-expiratory pressure me-chanicai ventilation suctioning as much edema fluidor sputum as possible, administration of diuretics, bolus of corticosteroids, and culture-based antibiotics. Hemeodialysis was indicated for patients with ol-iguric renal failure. Conclusions: ARDS is a serious multifactoral compli-cation after liver transplantation with a high mortal-ty and fatality. The most likely cause is fluid over-load from crystalloid liquid infusion or massive trans-fusion. The other predisposing or contributing fac-tors include sepsis, IV use of cyclosporine, fast ta-pering of corticosteroids, and gastric aspiration. Other factors such as transfusion-related acute lung injury (TRALI), and rep erfusion syndrome of the newly implanted liver may also contribute. Thoughthe treatment should primarily be supportive in na-ture, it is helpful to understand the predisposing and contributing factors and to aid in prevention, man-agement and treatment.