Rationale Pulmonary complications are common after Orthotopic Liver Transplant (OLT). The aim of study was to establish the incidence of pulmonary complications and associated mortality in first year after liver transplants in children at King’s College Hospital, London, one of the largest Paediatric Liver transplant centres in Europe.

Methods This was a retrospective study on children with OLT who developed pulmonary complications in the post transplant period. Medical records and radiology reports of children who had liver transplants from 2009–2011 were evaluated and incidence and outcome of acute pulmonary complications were determined. These complications were pleural effusion, atelectasis, consolidation, pulmonary oedema, pulmonary haemorrhage and diaphragmatic dysfunction. The association between these and mortality within one year was assessed. The incidence of chronic cough, new onset asthma and sleep related problems were also analysed during the one-year follow up.

Results The study included 146 children who underwent a total of 151 liver transplantations. Medical records were available for 148 transplant episodes. Median age was 2.5 years with an Inter Quartile Range (IQR) of 1.0 – 8.9 years. Out of 148 transplants, 74 (50%) developed pleural effusion (95% CI of OR 1.3 –2.3), 44/148 had atelectasis while more than half (78/148) had evidence of infiltrates or lobar consolidation (95% CI of OR 0.8 –1.7). Thirty-two had pulmonary oedema while only 3 had pulmonary hypertension or pulmonary haemorrhage. Twelve children died at the end of 1 year with a 92% survival rate. Amongst different causes of liver transplant, acute liver failure was statistically significant to cause pleural effusion, and a major cause of mortality. Pulmonary complications were independent of the medical condition at the time of occurrence, and did not predict mortality. The number of children with documented new onset asthma, chronic cough or sleep disordered breathing during the first year of follow up period was 3/148 (1.3%).

Conclusion Pulmonary complications are common after OLT. The mortality rate due to these pulmonary complications is lower than in previously reported studies. A study with a larger sample size and a long term follow up that primarily focuses on acute liver failure will confirm the association between the acute complications and mortality.