LTSI Consensus Guidelines: Preoperative Pulmonary Evaluation in Adult Liver Transplant Recipients

Area of Science:

• Pulmonology
• Hepatology
• Transplantation Medicine

Background:

• Chronic liver disease (CLD) is linked to respiratory symptoms and hypoxia.
• Key pulmonary complications include hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax.
• Pre-existing lung conditions like COPD and ILD can negatively impact liver transplant outcomes.

Purpose of the Study:

• To provide comprehensive recommendations for pulmonary screening in adults with CLD undergoing liver transplantation (LT).
• To standardize preoperative evaluation strategies for pulmonary issues in CLD patients.
• To address pulmonary complications related and unrelated to the underlying liver disease.

Main Methods:

• Consensus guideline development by the Liver Transplant Society of India (LTSI).
• Review of existing literature including case reports, small series, registries, and databases.
• Expert opinion synthesis to formulate recommendations.

Main Results:

• Identified three major pulmonary complications specific to CLD.
• Highlighted the impact of coexisting pulmonary diseases on LT outcomes.
• Acknowledged the limited availability of randomized controlled trials in this field.

Conclusions:

• Pulmonary evaluation is crucial for optimizing outcomes in CLD patients awaiting LT.
• Standardized preoperative assessment strategies are needed.
• Future research should address current evaluation gaps and challenges.