Pulmonary complications and perioperative outcomes after liver transplantation (LT) in Budd–Chiari Syndrome (BCS): A single center experience

B: BCS is a rare but life-threatening disorder caused by hepatic venous outflow obstruction, often resulting in progressive liver failure. LT is the definitive treatment for advanced BCS, but postoperative pulmonary complications (PPCs) are a significant source of morbidity. This study aimed to analyze perioperative characteristics and pulmonary outcomes in patients undergoing LT for BCS. M: We retrospectively reviewed patients who underwent LT for BCS at a single tertiary transplant center between 2017-2025. Demographics, perioperative detailed data were collected. PPCs were defined as pneumonia, pleural effusion, atelectasis, acute respiratory distress syndrome (ARDS), or prolonged mechanical ventilation (>48 h) within 30 days post-transplant. R: The cohort included 26 patients (mean age 45±12 years, 62% male, mean MELD score 19.5±5.9). Preoperative ascites and hepatic encephalopathy were present in 73% and 61% of patients, respectively; portal vein thrombosis was observed in 32%. Postoperatively, 11 patients (42%) developed PPCs, most commonly pleural effusion (27%) and pneumonia (19%). Prolonged mechanical ventilation was required in 12%, and ARDS developed in 4%. Patients with PPCs had significantly longer hospital stays (median 24 vs. 14 days, p = 0.03). In-hospital mortality was 11.5%, primarily among those with severe pulmonary and multiorgan dysfunction. C: Pulmonary complications are frequent after LT in BCS patients, reflecting the combined effects of venous congestion, ascites, and major surgery. Early respiratory support and careful perioperative fluid management are essential to improve outcomes in this high-risk population.