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

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 multi- variate 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 (post- mortal 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 ofpatients, immediate post- operative tracheal extubation should be the standard procedure after liver transplantation.