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

Hoffmeister, Roland; Stange, Barbara; Neumann, Ulf; Neuhaus, Peter; Glanemann, Matthias
January 2008
Open Surgery Journal;2008, Vol. 2, p43
Academic Journal
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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