Related Experiment Video
Updated: Jul 9, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Immediate extubation after pediatric liver transplantation: Update on a single-center experience
P Nina Scalise1, Donna C Koo1, Steven J Staffa2
1Department of Surgery, Harvard Medical School, Pediatric Transplant Center, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Immediate extubation after pediatric liver transplantation is safe and effective, leading to shorter intensive care unit and hospital stays. Increased center experience correlated with higher rates of successful immediate extubation, improving resource utilization.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Critical Care
Background:
- Immediate extubation (IE) is a growing practice in adult liver transplantation (LT).
- Data on IE in pediatric LT recipients is less established.
- This study evaluates IE in children undergoing LT at a single institution.
Purpose of the Study:
- To determine the feasibility and safety of immediate extubation in pediatric liver transplant recipients.
- To identify factors predictive of successful IE.
- To assess the impact of IE on post-operative outcomes, including intensive care unit (ICU) and hospital length of stay (LOS).
Main Methods:
- Retrospective chart review of 235 pediatric patients who underwent LT between January 2005 and November 2022.
- Exclusion criteria included concomitant lung transplants and chronic ventilator dependence.
- Analysis of patient characteristics, IE success rates, re-intubation rates, and post-operative outcomes.
Main Results:
- Immediate extubation was achieved in 69.8% of pediatric LT patients (164/235).
- Only two patients required re-intubation within 3 days post-transplant.
- IE was associated with significantly shorter ICU (2 vs. 4 days) and hospital LOS (17 vs. 22 days).
- Risk factors for failed IE included pre-transplant ICU stay, high PELD/MELD score, intraoperative transfusion, cold ischemia time, and pressor use.
- The rate of IE increased from 40% to 83% over the study period, reflecting growing institutional experience.
Conclusions:
- Immediate extubation is a safe and achievable strategy for pediatric liver transplant recipients across various clinical scenarios.
- Successful IE is linked to reduced ICU and hospital lengths of stay, enhancing patient mobility and resource efficiency.
- Increasing experience within transplant centers contributes to higher rates of successful IE, highlighting the importance of a learning curve.
Purpose:
Immediate extubation (IE) following liver transplantation (LT) is increasingly common in adult patients. This study reviews our center's experience with IE in children following LT to determine characteristics predictive of successful IE and its effects on post-operative outcomes.
Methods:
We performed a retrospective chart review of all patients who underwent LT at our institution between January 2005 and November 2022. Patients with concomitant lung transplants and chronic ventilator requirements were excluded.
Results:
Overall, 235 patients met study criteria. IE was achieved in 164 (69.8%) patients across all diagnoses and graft types. Of IE patients, only two required re-intubation within 3 days post-transplant. IE patients exhibited significantly shorter ICU (2 [1, 3 IQR] vs. 4 [2, 4 IQR] days, p < .001) and hospital lengths of stay (17 [12, 24 IQR] vs. 22 [14, 42 IQR] days, p = .001). Pre-transplant ICU requirement, high PELD/MELD score, intraoperative transfusion, cold ischemia time, and pressor requirements were risk factors against IE. There was no association between IE and recipient age or weight. The proportion of patients undergoing IE post-transplant increased significantly over time from 2005 to 2022 (p < .001), underscoring the role of clinical experience and transplant team learning curve.
Conclusion:
Spanning 18 years and 235 patients, we report the largest cohort of children undergoing IE following LT. Our findings support that IE is safe across ages and clinical scenarios. As our center gained experience, the rate of IE increased from 40% to 83%. These trends were associated with lower ICU and LOS, the benefits of which include earlier patient mobility and improved resource utilization.
