*Purpose: The American Society of Anesthesia recommends abdominal transplant patients receive pre-operative pulmonary function tests (PFTs) which cost nearly $2,500. Up to 88 percent of all orthotopic liver transplant patients experience post-operative pulmonary complications. We hypothesized that PFTs may not provide added clinical value to the pre-operative evaluation of liver transplant patients.

*Methods: We conducted a retrospective cohort study of consecutive adult cadaveric liver transplants from 2012 to 2018. Abnormal PFTs were defined as restrictive disease of DLCO <80% and or obstructive disease of FEV1/FVC <70%.

*Results: We analyzed data on 416 liver transplant patients (358 abnormal PFT results and 58 normal results). The liver transplant patients with abnormal PFTs had no difference in number of ICU days (p=0.67), length of stay (p=0.22), or intubation days (p=0.31). There was no difference in post-operative pulmonary complications including pleural effusion (p=0.30), hemo or pneumothorax (p=0.74), pneumonia (p=0.67), acute respiratory distress syndrome (p=0.58), or pulmonary edema (p=0.73). The significant finding between the two groups was a higher rate of reintubation in liver transplant patients with normal PFTs (p=0.02). There was no difference in graft survival (p=0.50) or patient survival (p=0.49).

*Conclusions: Abnormal pulmonary function tests were found in 86% of liver transplant patients but did not correlate with any post-operative complication, graft failure or mortality. Pulmonary function tests contribute to the high cost of liver transplants and do not help predict which patients are at risk of post-operative complications. Further investigation of alternative cost-effective pulmonary diagnostic exams is indicated.

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