Survival and resource utilization in liver transplant recipients: the impact of admission to the intensive care unit

Aggarwal, Avneep; Ong, Janus P.; Goormastic, M.; Nelson, David R.; Arroliga, Alejandro C.; Farquhar, Lou; Mayes, James T.; Younossi, Zobair M.

doi:10.1016/j.transproceed.2003.10.005

Cited by 14 publications

(6 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…11 In contrast, data from the Cleveland Clinic demonstrated that patient survival and graft survival were similar among patients who were in the ICU, patients who were hospitalized but not in the ICU, and patients outside the hospital at the time of their liver transplant. 7 Overall, these observations suggest that patients that are generally more ill at the time of OLT are at increased risk of PLOS. However, simply being more ill at the time of OLT does not lead to increased post-OLT mortality.…”

Section: Discussionmentioning

confidence: 91%

“…A number of studies have analyzed characteristics associated with patient and graft survival following OLT. [5][6][7][8][9][10] However, those factors that contribute to PLOS in the adult liver transplant recipient and the impact that PLOS has on patient and graft survival remain undefined. The incidence of PLOS was 13% in our cohort with a median hospital stay of 50 days versus only 10 days for those patients without PLOS.…”

Section: Discussionmentioning

confidence: 99%

“…4 Numerous studies in the adult population have analyzed the role of Model for End-Stage Liver Disease (MELD) scoring, hepatocellular carcinoma (HCC), hepatitis C virus (HCV), donor age, perioperative factors, and numerous other pre-OLT and post-OLT variables in patient and graft survival. [5][6][7][8][9] However, the contribution that these factors make to the length of transplant hospitalization remains undefined. The aim of the present study was to determine the incidence of prolonged length of stay (PLOS) in adult patients who undergo OLT, the factors associated with PLOS, and the impact of PLOS on both short-term and long-term patient and graft survival.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Incidence of prolonged length of stay after orthotopic liver transplantation and its influence on outcomes

et al. 2009

View full text Add to dashboard Cite

Orthotopic liver transplantation (OLT) is the only effective treatment for end-stage liver disease. Although most patients do well and are discharged promptly, some require prolonged length of stay (PLOS). The prevalence of PLOS, associated factors, and their impact on survival are not well defined. We reviewed our adult OLT database for patients who survived Ͼ 30 days. PLOS was defined as hospitalization Ͼ 30 days following OLT. Of 521 OLT recipients, 68 (13%) had PLOS with a median duration of 50 days versus only 10 days for patients discharged within 30 days. Significant differences in pre-OLT variables between patients with and without PLOS included the mean wait list time (P ϭ 0.001), hospitalization at the time of OLT (P ϭ 0.001), and prior OLT (P ϭ 0.041). Factors independently associated with PLOS included intensive care unit status at the time of OLT [odds ratio (OR), 4; 95% confidence interval (CI), 1.6-10.4], OLT prior to Model for End-Stage Liver Disease implementation (OR, 2.27; 95% CI, 1.04-5.26), in-hospital post-OLT bacterial infection (OR, 9.34; 95% CI, 4.65-18.86), gastrointestinal bleeding (OR, 4.34; 95% CI, 1.4-14.08), renal failure (OR, 10.86; 95% CI, 5.07-23.25), and allograft rejection (OR, 3.7; 95% CI, 1.23-11.11). One-year graft survival and patient survival were significantly less in those with PLOS (for both, P Ͻ 0.0001). Among PLOS patients, factors independently associated with increased 1-year mortality were donor age (OR, 1.07; 95% CI, 1.009-1.13), primary diagnosis of hepatitis C virus (OR, 6.89; 95% CI, 1.40-34.48), in-hospital post-OLT bacterial infection (OR, 13.3; 95% CI, 2.11-83.33), and cardiac complications (OR, 20.4; 95% CI, 1.51-250; c-statistic for the model, 0.85). In conclusion, PLOS following OLT is associated with a significant decrease in survival despite a marked increase in cost and resource utilization. Efforts to modify those factors that contribute to PLOS may reduce this event, improve survival, and reduce OLT-associated costs. Liver Transpl 15:273-279, 2009 Orthotopic liver transplantation (OLT) is the only definitive therapy for the treatment of end-stage liver disease. Although most recipients do well and are discharged within 2 weeks of transplantation, some patients require prolonged hospitalization, and this can dramatically increase both morbidity and the costs associated with OLT. Previous studies have demonstrated that a prolonged hospital stay following OLT most frequently occurs in patients without immediate bile production, in patients who have received more than 20 U of platelet transfusions during the transplant operation, in patients with poor urine output during the immediate post-OLT period, and in OLT recipients who develop multiorgan dysfunction. 1,2 A recent study has

show abstract

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Incidence of prolonged length of stay after orthotopic liver transplantation and its influence on outcomes

et al. 2009

View full text Add to dashboard Cite

show abstract

“…22 The influence of ICU admission on outcome has been evaluated after organ transplantation. Aggarwal et al 23 found no influence of preoperative ICU admission for liver failure on survival after orthotopic liver transplantation. At our institution, patients are not routinely admitted to the ICU after PD.…”

Section: Discussionmentioning

confidence: 98%

Predictors of Intensive Care Unit Admission and Related Outcome for Patients After Pancreaticoduodenectomy

Bentrem¹,

Yeh²,

Brennan³

et al. 2005

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

“…In another study that examined patient and graft survival after LDLT in adult recipients who received ICU care before transplant, there was no Abbreviation: ESBL, extended-spectrum β-lactamase producer; MRCNS, methicillin-resistant coagulase-negative staphylococci; MRSA, methicillinresistant Staphylococcus aureus difference in survival between the patient groups; in that study, factors that may have affected outcome such as age, sex, race, cause of disease, and cold ischemia time were similar between the patient groups. 21 We observed that low pretransplant platelet count was associated with poor outcome in our children, and another study reported that low posttransplant platelet count may predict early posttransplant survival. 22 The enzyme GGTP is a microsomal enzyme that is distributed widely in human tissues that are involved in secretory and absorptive processes, particularly the bile canaliculi.…”

Section: Discussionmentioning

confidence: 46%

Untitled

2015

Exp Clin Transplant

View full text Add to dashboard Cite

Objectives: The outcome of children who had livingdonor liver transplant was analyzed according to their status before transplant, and we analyzed the outcome of critically ill patients. Materials and Methods:This was a retrospective analysis of children who received primary livingdonor liver transplant at Kyoto University Hospital. According to the criteria of the United Network for Organ Sharing, we divided patients into 3 groups: Group A patients had been admitted to the intensive care unit before living-donor liver transplant; Group B patients were hospitalized but did not require intensive care unit stay; and Group C patients were living at home and underwent elective transplant. Results: A total 685 patients met inclusion criteria. Children in Group A were younger than Group B and received liver grafts from younger donors than Group B and C. Group A patients had marked impairment in liver and renal function and coagulation profile and needed higher volumes of fresh frozen plasma transfusions. Group A patients had significantly worse outcomes and early patient death than the other group; Group A patient survival was 68.3%, 63.2%, 60.1%, and 56.1% at 1, 5, 10, and 15 years after living-donor liver transplant (P < .0001). Group A had worse graft survival than other groups (P < .0001), and Group A graft survival was 68.3%, 65.9%, 54.1%, and 49.9% at 1, 5, 10, and 15 years. Low gamma-glutamyl transpeptidase was an independent risk factor for patient death in Group A (hazard ratio, 1.004; 95% confidence interval, 1.0-1.007) (P < .05). Group A patients had a higher rate of multidrug-resistant hospital-acquired infections. Conclusions: Children who were admitted to the intensive care unit prior to living-donor liver transplant had marked impairment of pretransplant laboratory parameters and worse outcome than other groups.

show abstract

Survival and resource utilization in liver transplant recipients: the impact of admission to the intensive care unit

Cited by 14 publications

References 11 publications

Incidence of prolonged length of stay after orthotopic liver transplantation and its influence on outcomes

Incidence of prolonged length of stay after orthotopic liver transplantation and its influence on outcomes

Predictors of Intensive Care Unit Admission and Related Outcome for Patients After Pancreaticoduodenectomy

Untitled

Contact Info

Product

Resources

About