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Published on: July 1, 2012
Relationship Between Postoperative Acute Kidney Injury and Early Extubation After Pediatric Liver Transplant
Helin Sahinturk1, Bugra Aykenar, Ahmed Uslu
1From the Department of Anesthesiology and Critical Care, Baskent University Faculty of Medicine, Ankara, Turkey.
Insights
Early extubation in the operating room after pediatric liver transplant did not increase the risk of acute kidney injury. However, early extubation was associated with a higher need for open-abdomen procedures.
Area of Science:
- Pediatric Surgery
- Nephrology
- Transplantation
Background:
- Postoperative acute kidney injury (AKI) is a significant complication following pediatric liver transplantation.
- AKI can lead to severe short-term and long-term health issues in young patients.
Purpose of the Study:
- To investigate the hypothesis that early extubation in the operating room reduces the incidence of AKI after pediatric liver transplant.
- To analyze the association between early extubation and postoperative AKI in pediatric liver transplant recipients.
Main Methods:
- Retrospective cohort study of pediatric liver transplant recipients (<18 years) from 2012-2020.
- Patients were categorized based on extubation timing: in the operating room (early) versus in the intensive care unit.
- Medical records were reviewed to assess AKI development and other postoperative outcomes.
Main Results:
- Early extubation in the operating room occurred in 65.2% of 132 pediatric liver transplant recipients.
- No statistically significant difference in AKI incidence was observed between early extubation and later extubation groups (18.6% vs 17.4%).
- Early extubation was linked to a higher rate of open-abdomen procedures but shorter intensive care unit and hospital stays.
Conclusions:
- Early extubation in the operating room is not associated with an increased risk of acute kidney injury in pediatric liver transplant patients.
- While not impacting AKI, early extubation may necessitate further surgical intervention but offers benefits in reduced length of stay.
Objectives:
Postoperative acute kidney injury after pediatric liver transplant is a serious complication with considerable short-term and long-term consequences. We hypothesized that incidence of postoperative acute kidney injury after pediatric liver transplant is lower among patients extubated early after surgery in the operating room.
Materials And Methods:
In this retrospective cohort study, we reviewed the medical records of all patients aged <18 years who underwent liver transplant from January 2012 to December 2020. Early extubation was defined as extubation in the operating room. Children were divided into 2 groups: those who were extubated in the operating room and those who were extubated in the intensive care unit.
Results:
A total of 132 pediatric liver transplant recipients were analyzed. The mean age of transplant was 58.2 ± 60.1 months, and 54.5% were male recipients. Early immediate tracheal extubation in the operating room was performed in 86 patients (65.2%). Postoperative acute kidney injury was seen in 24 children (18.2%) of which 15 (11.4%) had stage 1 acute kidney injury, 8 (6.1%) had stage 2, and 1 (0.8%) had stage 3. There was no statistically significant difference between the 2 groups regarding development of acute kidney injury (18.6% vs 17.4%; P > .05). Compared with patients who were not extubated in the operating room, the need for an open-abdomen procedure (76.9% vs 23.1%; P = .001) was significantly higher in patients who were extubated in the operating room. Durations for length of stay in the intensive care unit and hospital were significantly shorter in patients who were extubated in the operating room (P < .001).
Conclusions:
Our results showed that early extubation was performed in nearly two-thirds of our cohort. There was no association between early extubation and development of acute kidney injury among pediatric liver transplant recipients.
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Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....