OR Extubation of Liver Transplant (LT) Patients is Associated with Significantly Less Blood Transfusion During Surgery, Acute Renal Failure and Bacterial Infection, and Shorter Hospital and ICU Stay

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A retrospective analysis of our data was performed to determine the rate of OR extubation after liver LT. The records of 194 patients who underwent LT from January 2005 to December 2017 were reviewed retrospectively. We excluded 81 patients due to retransplantation (15), combined liver and kidney transplantation (17), liver emergency (20), Living donor LT (16) or patients with perioperative mortality within 7 days after surgery (13). Finally, we compared the main immediate postoperative complications in the extubation group (n = 36) versus the group with delayed extubation (n = 77) in the same period.The rate of OR extubation (group A) vs ICU extubated patients (group B) increased significantly from 4.3% during our first transplant era (years 2005-2012, n=46) to 50.7% during the second era (2013-2017, n=67). Both groups were similar in age, sex, body mass index and cause of liver failure. Average MELD score was significantly lower for group A (18.5 vs. 24.1, p=0.013).Group A vs group B patients respectively had significantly less need for blood transfusion in average (1.8 vs 5.2 packed red blood cells, p<0.001), lower bacterial infection rate (20.8% vs 45.5%, p=0.035), shorter average ICU stay (4.3 vs 9.7 days p=0,005), shorter average total hospitalization (10.9 vs 17.1 days, p=0.04) and lower acute renal failure rate (40% vs 68,8%, p=0.04).A subanalysis was performed for patients with a MELD score ≤ 20. Group A patients (n=25) had a significantly shorter average ICU stay (3.6 days vs. 12 days, p=0.009), shorter total average hospital stay (11.3 days vs. 22 days, p=0.04) and a significantly lower rate of bacterial infection (24% vs. 54.8%, p=0.02). There was less need for transfusion of red blood cell concentrate in average for group A (1.5 vs. 4.3 units, p<0.001).

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