Immediate extubation following pediatric liver transplantation

Abstract

Background Immediate extubation (IE) following pediatric liver transplantation is being increasingly performed. The aim of this study was to characterize the rate of IE at our institution and identify recipient factors predictive of IE. Methods All pediatric liver transplants performed at our institution between January 1, 2015 and December 31, 2020 were reviewed. Retransplants and multi‐organ transplants were excluded. IE was defined as extubation in the operating room following transplant. Backward stepwise logistic regression at a p‐value threshold of .05 was performed to identify variables associated with IE. Results IE was achieved in 58 (72%) of the 81 pediatric liver transplants. The IE cohort had significantly shorter ICU length of stay and overall hospital length of stay, though IE was not an independent predictor of posttransplant length of stay. Age <2 years, preoperative mechanical ventilation, and total intraoperative epinephrine and dopamine infusion requirements were significant, independent risk factors against IE. This multivariable model was highly predictive of IE (area under the curve = 0.89). Conclusions We describe the highest rate of IE postpediatric liver transplantation that has been reported to date and identified significant risk factors against successful IE.

Criteria for immediate extubation after pediatric liver transplantation in a single pediatric liver transplant center in Japan

“…5,7 In addition, high-dose vasopressor use during surgery has been identified as a risk factor. 5,6 These findings are consistent with our results. However, there are no reports indicating that GWRW hinders IE.…”

“…Indicating that our preoperative selection criteria for IE after pediatric LT could select cases presenting with the risk factors reported in previous articles. [5][6][7][8][9] Our results on postoperative outcomes are similar to several previous reports. 5,6,7,9 Yoeli et al…”

“…However, there are no reports indicating that GWRW hinders IE. Yoeli et al investigated the relationship between body weight and IE, using a cutoff of 30 kg, 6 finding significantly fewer IE cases in children < 2 years old but did not go further in their analysis. Our preoperative selection criteria do not specifically include patient age; instead, recipients weighing < 6 kg were classified into the NIE group based on our criteria.…”

“…5 Yoeil et al reported that 72% pediatric LT cases attempted IE. 6 Additionally, Gurnaney et al reported 57.8% of early extubation after pediatric LT. 7 For pediatric living donor liver transplantation (LDLT), Pandey et al reported the safety of protocolized IE approach, wherein high vasopressor support was identified as an independent predictor of non-immediate extubation. 8 Additionally, Saeyup et al reported that 39% of pediatric LDLT cases were able to tolerate IE, with the only associated factor being an-hepatic time.…”

The Development of an Enhanced Recovery Protocol for Kasai Portoenterostomy

“…Epidural anesthesia, a regional anesthesia technique to limit opioid use, has been shown to shorten extubation times and hospital stays in Kasai patients [ 7 ]. Early extubation has been shown to be safe in similar populations including infants receiving pediatric liver transplant [ 8 , 9 , 10 ]. In addition, early extubation in liver transplants was shown to decrease pediatric intensive care unit (PICU) stays and overall hospital stays [ 8 ].…”