Perioperative risk factors for prolonged mechanical ventilation after liver transplantation due to acute liver failure

Abstract

BackgroundAcute liver failure (ALF) is a rapidly progressing and fatal disease for which liver transplantation (LT) is the only treatment. Posttransplant mechanical ventilation tends to be more prolonged in patients with ALF than in other LT patients. The present study examined the clinical effects of prolonged posttransplant mechanical ventilation (PMV), and identified risk factors for PMV following LT for ALF.MethodsWe reviewed data of patients undergoing LT for ALF between January 2005 and June 2011. After grouping patients according to administration of PMV (≥ 24 h), donor and recipient perioperative variables were compared between the groups with and without PMV. Potentially significant factors (P < 0.1) from the univariate intergroup comparison were entered into a multivariate logistic regression to establish a predictive model for PMV.ResultsTwenty-four (25.3%) of 95 patients with ALF who received PMV had a higher mortality rate (29.2% vs 11.3%, P = 0.038) and longer intensive care unit stay (12.9 ± 10.4 vs 7.1 ± 2.7 days, P = 0.012) than patients without PMV. The intergroup comparisons revealed worse preoperative hepatic conditions, more supportive therapy, and more intraoperative fluctuations in vital signs and less urine output in the with- compared with the without-PMV group. The multivariate analysis revealed that preoperative hepatic encephalopathy (≥ grade III), intraoperative blood pressure fluctuation, and oliguria (< 0.5 ml/kg/h) were independent risk factors for PMV.ConclusionsPMV was associated with deleterious outcomes. Besides care for known risk factors including hepatic encephalopathy, meticulous attention to managing intraoperative hemodynamic circulatory status is required to avoid PMV and improve the posttransplant prognosis in ALF patients.

Prolonged Mechanical Ventilation Predictors in Patients Undergoing Liver Transplantation

“…In a recent study by Prasad et al (14) the volume of blood products used in patients undergoing orthotopic liver transplantation was found to be a significant predictor of postoperative poor outcome. In our study, although the amount of transfusion of erythrocyte suspension and FFP was very low compared with the other studies (15,16), it was found to be higher in the prolonged mechanical ventilation group than the other group without reaching statistical significance. On the other hand, the use of cryopresipitat was found to be statistically significantly higher in the prolonged mechanical ventilation group.…”

“…Another risk factor for prolonged mechanical ventilation is preoperative poor condition. There are many studies in the literature that show that high ASA and MELD scores are associated with poor outcomes (14,15,23). In our study, ASA and MELD scores were significantly higher in the prolonged mechanical ventilation group, but the effect of age, gender and comorbid disease on mechanical ventilation duration was not shown.…”

Risk factors of prolonged mechanical ventilation after liver transplantation: a retrospective cohort study

“…Many current studies have found that a high MELD score is a risk factor for PMV after liver transplantation [14,26,29]. The MELD score is a commonly used score to evaluate the severity of endstage liver disease and has a valuable correlation with the prognosis of patients after liver transplantation.…”

The Edge of Unknown: Postoperative Critical Care in Liver Transplantation

“…Prolonged mechanical ventilation after LT is associated with worse outcomes [ 29 , 30 , 31 ]. The first study describing the early benefits of extubation after LT in combination with restrictive fluid management was published in 1990 by Rossaint et al [ 32 ].…”