Tracheostomy Following Liver Transplantation.

Area of Science:

• Hepatology
• Critical Care Medicine
• Surgical Outcomes

Background:

• Increasing demand for liver transplantation leads to more sicker patients undergoing the procedure.
• These patients face a higher risk of postoperative complications, particularly respiratory failure.

Purpose of the Study:

• To identify patient characteristics (phenotype) that predict the need for tracheostomy in liver transplant candidates.
• To evaluate the impact of early tracheostomy on outcomes for high-risk liver transplant recipients.

Main Methods:

• A retrospective review of liver transplant candidates at a single center from January 2012 to December 2017.
• Comparison of patients who required tracheostomy with those who did not.

Main Results:

• Eleven out of 130 liver transplant recipients required tracheostomy.
• Tracheostomized patients had higher Model for End-Stage Liver Disease (MELD) scores (37 vs. 30) and lower oxygenation ratios (PaO2/FiO2).
• Tracheostomized patients experienced longer ventilation, longer hospital stays, and higher 1-year mortality.

Conclusions:

• Patients with a high MELD score (>30), significant postoperative fluid overload (>6 L), and an oxygenation ratio (PaO2/FiO2) ≤300 may benefit from tracheostomy.
• Early tracheostomy should be considered for patients failing to wean from mechanical ventilation after 72 hours.