Surgical chest complications after liver transplantation

Table 1 List of complications and prevention measures

Timing of complication	Type of complication	Prevention measures
Intraoperative	Pneumothorax	High level of suspicion
		Cautious OT intubation
		CVC placement under echography guidance
		Low airway pressures during mechanic ventilation
		Closure of diaphragmatic defects encountered during LTx
Early postoperative	Pleural effusion	Correction of hypoproteinemia
		Limited perioperative blood transfusions
		Proper surgical technique
		Preventive chest tube placement
	Pneumothorax	Echographic guidance for percutaneous pleural procedures
	Hemothorax	Correction of coagulopathy
		Echographic guidance for percutaneous pleural procedures
		Proper surgical technique during LTx
	Atelectasis	Pain management
		Chest physiotherapy
		Drainage of pleural effusions
	Chest tube misplacement	Proper surgical technique
	Re-expansion pulmonary edema	Staged evacuation of massive pleural effusions
	Bacterial pneumonia	Chest physiotherapy
		Early extubation and weaning from mechanical ventilation
		Prevention and treatment of atelectasis
	Pleural empyema	Drainage of parapneumonic pleural effusions
Mid-term and chronic	Opportunistic infections causing lung necrosis and cavitation	Proper prophylaxis
	Invasive aspergillosis	High clinical suspicion
		Prompt imaging (CT scan)
	Diaphragmatic herniation	Proper surgical technique during LTx
	Trapped lung	Prompt treatment of pleural effusion before chronicity
		Radical treatment of pleural empyema

CT: Computed tomography; CVC: Central venous catheter; LTx: Liver transplantation; OT: Orotracheal.