To determine the types and the incidence of as well as risk factors for early postoperative (<30 days) respiratory complications in adult liver transplant (LT) recipients, we reviewed The data of 44 consecutive adult LT recipients who received their grafts from January 1995 through December 2002. The data included demographic features; primary diagnosis; number of intraoperative transfusions; preoperative and postoperative laboratory values; intraoperative and postoperative characteristics; and early postoperative (<30 days) mortality. Pulmonary atelectasis, pleural effusion, pneumonia, respiratory failure, and pulmonary edema were the respiratory complications investigated. Twenty-six patients (59.1%) developed at least one respiratory complication during the early postoperative period. The most frequent complication was pleural effusion (n = 18, 40.9%), followed by atelectasis (n = 13, 29.5%), pneumonia (n = 10, 22.7%), acute respiratory failure (n = 5, 11.4%), pulmonary edema (n = 3, 6.8%), and pneumothorax (n = 2, 4.5%). Compared to the patients who did not develop these problems, the affected cohort was significantly older (27 +/- 12 years vs 36 +/- 14 years, respectively; P =.039) and required more intraoperative transfusions (P =.005). Among the overall mortality rate of 15.9%, patients who developed pneumonia showed a significantly higher mortality (40.0% vs 8.8%, respectively; P =.037). Pleural effusion, atelectasis, and pneumonia are the main respriatory complications that occur in adult LT recipients. Patient age and intraoperative transfusion requirements are important predictors of early postoperative complications. Pneumonia is associated with a poor prognosis in this patient group.