Failure of Immediate Tracheal Extubation After Liver Transplantation - A Single Center Experience

ABSTRACT

Fast tracking approaches in liver transplantation include postoperative extubation immediately after surgery in the operating theatre. Based on the experience of 837 liver transplantations performed between 01/97 and 05/05, we report on the safety and feasibility of this procedure in almost 80% of transplant recipients, without increasing the incidence of subsequent reintubation (11%). This patient population experienced significantly higher survival compared to patients in whom extubation succeeded at the intensive care unit (p<0.02). Special attention was required for recipients with acute liver failure or retransplantation. These patients did not participate in fast tracking protocols, as demonstrated by a multivariate regression analysis. In this context, failure of immediate tracheal extubation was independent of cold ischemic time, duration of surgery, donor / recipient age or gender, extent of preservation injury, or type of organ donation (postmortal vs living-related). ROC analysis revealed that only intraoperative transfusions of ≤6 units of red blood cells were associated with primary extubation in the operating theatre with high sensitivity and specifity. To conclude, postoperative mechanical ventilation is justified only in a small cohort of recipients. For the vast majority of ≤ patients, immediate postoperative tracheal extubation should be the standard procedure after liver transplantation.

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