Immediate Extubation of Children Following Liver Transplantation Is Safe and May Be Beneficial

Me, O'Meara; Sm, Whiteley; Jm, Sellors; Jm, Luntley; Davison, Suzanne; McClean, Patricia; Rajwal, Sanjay; Prasad, Raj

doi:10.1097/01.tp.0000174132.18652.81

Cited by 36 publications

(53 citation statements)

References 11 publications

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“…Median intraoperative blood transfusion requirement was 35 ml/kg; one child required no blood transfusion. Most children were extubated immediately after the transplant according to our unit policy [5]. Median ICU stay was 2.5 days and median postoperative hospital stay was 21 days (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Does the pediatric end-stage liver disease score or hepatic artery resistance index predict outcome after liver transplantation for biliary atresia?

2006

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The pediatric end-stage liver disease score (PELD) was devised and validated as a tool for predicting mortality and morbidity in children with chronic liver disease waiting for a liver transplant (LT). It has become a useful guide for prioritizing organ allocation in the United States. The hepatic artery resistance index (HARI) also predicts waiting list mortality in children with biliary atresia. Does the PELD score or HARI predict outcome after LT for biliary atresia? Twenty consecutive children who underwent LT for biliary atresia between 2001 and 2005 were reviewed. Their PELD score was calculated periodically between listing and transplantation and HARI was measured at listing. Outcome variables were operative blood transfusion requirements, ICU stay and postoperative stay. Median age at LT was 8 (2-204) months. After allowing for the type of graft, the PELD score and the change in PELD score between listing and LT (deltaPELD) showed no significant correlation with blood transfusion requirements, but both the PELD score at listing and deltaPELD showed a trend toward a statistically significant positive correlation with overall hospital stay. Pre-transplant HARI showed a statistically significant positive correlation with the PELD score at listing (r = 0.46, p = 0.05) but did not correlate significantly with hospital stay. In this relatively small but homogeneous group of children undergoing LT for biliary atresia, PELD, and deltaPELD scores showed a trend toward a statistically significant positive correlation with overall hospital stay. However, neither PELD scores nor the pre-transplant HARI showed a definite correlation with outcome. Post-transplant complications are probably more important factors determining ICU and hospital stay in children currently transplanted for biliary atresia.

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Section: Resultsmentioning

confidence: 99%

Does the pediatric end-stage liver disease score or hepatic artery resistance index predict outcome after liver transplantation for biliary atresia?

2006

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“…New evidence shows that routine ventilation is not always required in this special group of patients, even if they undergo large surgery. Thus, investigators now describe successful IPE following cardiac surgery in patients with impaired left ventricular function [18], congenital pediatric heart defects [19] and after single lung transplantation [20 ] and liver transplantation in pediatric patients who weigh less than 10 kg [21].…”

Section: History Of Immediate Postoperative Extubation In Liver Transmentioning

confidence: 99%

The clinical value of early extubation

Mandell¹,

Campsen

Zimmerman

et al. 2009

Current Opinion in Organ Transplantation

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There is robust evidence to support the use of immediate postoperative ventilation in liver transplant recipients. There is no evidence, however, to show that routine ventilation of all transplant recipients provides outcomes that are as good as those documented in extubated patients. It is probably time to turn the evidentiary tables around and ask proponents of routine ventilation to prove that they have done no harm and that they meet the new minimal performance standards established by immediate postoperative extubation.

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“…Mandell et al reported by means of a multivariate logistical regression analysis of 147 patients, that encephalopathy and body mass index (>35) were criteria for failure of primary extubation in the operating theatre [27]. O'Meara et al reported on similar findings in pediatric transplantations [24], and Biancofiore et al reported of a multivariate logistical regression analysis of 168 patients who received primary extubation within the first three postoperative hours [14].…”

Section: Discussionmentioning

confidence: 51%

“…This approach was associated to be safe for the recipient, without any increased incidence for reintubation [13,14,23], and is applicable for both the pediatric liver transplantation as well as the living-related liver donation [12,16,24]. Further advantage is the reduction in the costs due to the decreased utilization of intensive capacities, which are noted in an American study to be approximately 13% of the total costs of a liver transplantation [25].…”

Section: Discussionmentioning

confidence: 95%

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

Hoffmeister¹,

Stange²,

Neumann³

et al. 2008

TOSJ

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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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Immediate Extubation of Children Following Liver Transplantation Is Safe and May Be Beneficial

Abstract: Immediate extubation of selected children after OLT is safe. It may enhance patient recovery, benefit graft physiology, and reduce intensive care requirement.

Cited by 36 publications

References 11 publications

Does the pediatric end-stage liver disease score or hepatic artery resistance index predict outcome after liver transplantation for biliary atresia?

Does the pediatric end-stage liver disease score or hepatic artery resistance index predict outcome after liver transplantation for biliary atresia?

The clinical value of early extubation

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

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