Recent advances in early post-liver transplant pulmonary complications

Abstract Postoperative pulmonary complications (PPCs) in the early period following liver transplantation represent a significant clinical issue contributing to increased morbidity and mortality. This systematic review examines the pathophysiological mechanisms, risk factors, and prevention strategies for PPCs. Key pathophysiological drivers include dysregulated inflammatory responses (e.g., neutrophil extracellular trap release), impaired right heart-lung vascular interactions, and intestinal microbiota translocation. Primary risk factors comprise preoperative hepatic reserve, pulmonary dysfunction, and intraoperative fluid overload. Prevention and management strategies emphasize perioperative multidisciplinary collaboration: preoperative pulmonary rehabilitation and nutritional supplementation can mitigate inflammation; intraoperative goal-directed fluid management and lung-protective ventilation reduce pulmonary edema risk; and early postoperative rehabilitation enhances quality of life. Promising future directions including microbiome modulation and multi-omics analysis hold potential to optimize personalized intervention strategies and improve long-term patient outcomes, though their clinical efficacy remains to be further validated.