Tracheostomy Post Liver Transplant: Predictors, Complications, and Outcomes

Area of Science:

• Hepatology
• Transplant Surgery
• Critical Care Medicine

Background:

• Liver transplant (LT) recipients face a higher risk of postoperative respiratory failure, often necessitating tracheostomy.
• Identifying predictors of tracheostomy is crucial for improving patient outcomes.

Purpose of the Study:

• To identify objective clinical predictors of tracheostomy in liver transplant patients.
• To characterize the outcomes associated with tracheostomy in this population.

Main Methods:

• Retrospective review of 2017 liver transplant patients.
• Case-control analysis matching 98 tracheostomy patients with 98 non-tracheostomy patients.
• Preoperative muscle mass assessment using computed tomography scans.

Main Results:

• 98 (5%) LT patients required tracheostomy, experiencing higher complication rates.
• Tracheostomy patients were older, had higher Model for End-Stage Liver Disease (MELD) scores, lower body mass index (BMI), and greater smoking history.
• Tracheostomy was associated with significantly longer hospital stays and worse 1-year and 10-year survival rates.
• Muscle mass deficit (sarcopenia) was a significant predictor in case-control analysis.

Conclusions:

• Higher MELD score, older age, lower BMI, smoking history, and sarcopenia predict respiratory failure requiring post-LT tracheostomy.
• Tracheostomy in LT patients is linked to substantially prolonged hospitalization and diminished survival.