Impact of Postoperative Pulmonary Complications on Clinical Outcomes in Liver Transplantation: A Single-Center Retrospective Analysis

Background Liver transplantation (LT) is the definitive treatment for end-stage liver disease. However, postoperative pulmonary complications (PPCs) significantly contribute to morbidity and mortality. This study aims to analyze the incidence, risk factors, and clinical impact of PPCs in adult LT recipients. Methods We retrospectively analyzed 86 adult patients who underwent LT at our tertiary referral center. Patients were categorized based on the development of PPCs, including pleural effusion, atelectasis, ARDS, pneumonia, and the need for reintubation. Demographic data, perioperative variables, and clinical outcomes (ICU stay, hospital stay, and 30-day mortality) were compared. Results The overall incidence of PPCs was 46.5%. Atelectasis (32.6%) and reintubation (22.1%) were the most frequent complications. Patients with PPCs had a significantly longer median ICU stay (11.0 vs. 4.0 days, p < 0.001) and hospital stay (19.5 vs. 16.5 days, p = 0.045). Smoking history (pack-years) was significantly associated with PPC development (p = 0.027). The 30-day mortality rate was 19.8% for the entire cohort. Mortality was more frequent among patients with PPCs (25.0% vs. 15.2%), although this difference did not reach statistical significance (OR 1.86, 95% CI 0.63–5.46). Conclusion PPCs are highly prevalent after LT and are associated with prolonged resource utilization. Smoking is a modifiable risk factor that predicts PPCs. Early identification and aggressive perioperative respiratory management are crucial to improving outcomes in LT recipients.