Pulmonary Complications After Solid Organ Transplantation

Introduction: Solid-organ transplantation (SOT) is considered the main treatment option for patients with end-stage organ failure. We aimed to evaluate the incidence, outcomes and identify the risk factors of pulmonary complications after SOT.


Methods: A retrospective, observational, single-center study was conducted on 1635 adult patients after SOTs including 1511 kidney and 124 liver transplants. Data were collected from medical records at our hospital. The data included initial clinical information obtained during hospitalization for each patient, intraoperative course characteristics, and patient parameters after surgery, as well as pulmonary complications (pleural effusion, atelectasis, pulmonary edema, pneumonia and acute respiratory distress syndrome (ARDS)) and other clinical outcomes.


Results: In liver transplant recipients, the incidence of pulmonary complications during the early postoperative period was 30%. The etiology of the pulmonary complications was pleural effusion in 62.1%, pneumonia in 8.1%, atelectasis in 4.8%, pulmonary edema in 6.4%, and ARDS in 12.9% patients. The identified perioperative risk factors were: elevated white blood cell count (OR=1.6 per 1×10⁹/L; 95%CI: 1.1–2.3), increased neutrophil-to-lymphocyte ratio (OR=2.0 per unit; 95%CI: 1.1–3.8), decreased arterial oxygen tension (PaO₂) (OR=0.9 per mm Hg; 95%CI: 0.9–1.1), and lower INR values (OR=0.004 per unit; 95%CI: 0.0–0.5). In adult kidney recipients, pulmonary complications were less frequent (20.5%) and mostly secondary to noninfectious reasons early after surgery, whereas late respiratory failure frequently was due to infectious causes. Risk factors were age over 40 years (OR=2.8; 95%CI: 1.1-7.5), development of post-transplant diabetes (OR=3.1; 95%CI 1.0-9.3), need for posttransplant dialysis (OR=5.1; 95%CI: 1.2-21.4), acute (OR=6.5; 95% CI: 2.0-20.8) and chronic kidney transplant rejection (OR=11.9; 95%CI: 4.0-15.4).


Conclusions: Liver transplant recipients are more likely to develop early pulmonary complications. In contrast, kidney transplant recipients tend to have more frequent long-term pulmonary complications and are often associated with infections and comorbidities. The identified risk factors may help guide early detection and treatment strategies.