Predictors of success of immediate tracheal extubation in living donor liver transplantation recipients()

BACKGROUND: Early tracheal extubation of recipients following liver transplantation (LT) has been gradually replacing the standard postoperative prolonged mechanical ventilation, contributing to better patient and graft survival and reduced costs. There are no universally accepted predictors of the success of immediate extubation in LT recipients. We hypothesized several potential predictors of successful immediate tracheal extubation in living donor liver transplantation (LDLT) recipients. AIM: Evaluation of 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 investigation, perioperative data of adult living donor liver transplantation (LDLT) recipients were recorded. “Immediate extubation” was defined as tracheal extubation immediately and up to 1 hour post-transplant in the operating room. Patients were divided into the extubated group who were successfully extubated with no need for reintubation, and the non-extubated group who failed to meet the criteria of extubation, or were re-intubated within 4 hours of extubation. RESULTS: We enrolled 64 patients candidates for LDLT; 50 patients (76.9%) in group 1 were extubated early after LDLT while 14 patients (23.07%) in group 2 were transferred to the intensive care unit intubated. After data analysis, we found that EOS serum lactate, duration of surgery and number of packed RBCs units transfused intraoperatively were good predictors of success of immediate extubation (p < 0.001). MELD scores did not show any significant impact on the results (p = 0.54). Other factors such as EOS urine output and blood gases indices were shown to have a significant effect on the decision of extubation (p = 0.03 and 0.006, respectively). CONCLUSIONS: EOS serum lactate, duration of surgery and number of packed RBCs units transfused were potential predictors of post-transplant early extubation.