This study evaluated the effect of adjunctive incentive spirometer on arterial blood gases (ABGs) and early postoperative recovery in liver transplant recipients.

In this prospective , randomized study, 40 adults undergoing living-donor liver transplantation (LT) were assigned to standard post-transplant mobilization and breathing exercises alone (n=20) or standard exercises plus structured IS training (n=20). Arterial blood gases ABG parameters (pH, PO₂, PCO₂, HCO₃-, SpO₂) were measured at baseline and on postoperative days 1-3. Linear mixed-effects models assessed group differences in ABG trajectories; slope analyses quantified decline and recovery phases. Secondary outcomes included intensive care unit (ICU) and hospital length of stay (LOS) and Post-operative pulmonary complications incidence.

Inclusion Criteria:

1. age between 18 and 65 years,
2. scheduled to undergo Living Donor Liver Transplant (LDLT) as recipients
3. able to understand and follow instructions for incentive spirometry use

Exclusion Criteria:

1. multiorgan transplantation
2. moderate-to-severe pleural effusion at baseline
3. persistent elevation in renal function tests
4. history of bleeding esophageal varices within the preceding month
5. multicentric hepatocellular carcinoma (HCC)
6. active smoking
7. decompensated cardiac disease
8. alcoholic hepatitis as the primary etiology
9. cognitive impairment or blindness precluding participation in the rehabilitation protocol.