Predictors of Success of Immediate Tracheal Extubation in Living Donor Liver Transplantation Recipients

Abstract

Background Early tracheal extubation of recipients following liver transplantation (LT) has been promoted and gradually replacing standard postoperative prolonged mechanical ventilation, possibly contributing to better graft and patient survival and reduced costs. There are no universally accepted predictors of success of immediate extubation in LT recipients. We hypothesized a number of factors as predictors of successful immediate tracheal extubation in living donor liver transplantation (LDLT) recipients. Aim The aim of this study was to evaluate the validity of the following hypothesized factors: Model for end stage liver disease (MELD) score, duration of surgery, number of intraoperatively transfused packed red blood cells (RBCs) units and end of surgery (EOS) serum lactate, as predictors of success of immediate tracheal extubation in living donor liver transplantation (LDLT) recipients. Methods In this prospective clinical trial, perioperative data of adult LDLT recipients were recorded. “Immediate extubation” was defined as tracheal extubation immediately and up to 1 hour postransplant in the operating room. Patients were divided into; extubated group who were successfully extubated with no need for reintubation, and non-extubated group who failed to meet criteria of extubation or were re-intubated within 4 hours of extubation. Results Of 64 patients, 50 (76.9%) were extubated early after LDLT while 14 (23.07%) were transported to the intensive care unit (ICU) intubated. After data analysis, it was found that EOS serum lactate, duration of surgery and number of packed RBCs units transfused intraoperatively, were good predictors of success of immediate extubation, while MELD scores had no statistically significant impact on the results. In addition, other factors such as EOS urine output and pH were shown to have significantly affected the results. Conclusions EOS serum lactate, duration of surgery and number of packed RBCs units transfused were predictors of post-transplant early extubation.