Off the Vent and on the Mend: Predicting Successful On-Table Extubation Following Liver Transplantation

Area of Science:

• Hepatology
• Transplant Surgery
• Critical Care Medicine

Background:

• Liver transplantation historically involves prolonged intubation.
• Early extubation offers improved patient outcomes and reduced resource utilization.
• Developing predictive models for early extubation is crucial for optimizing post-transplant care.

Purpose of the Study:

• To develop a predictive model for early extubation in liver transplant recipients.
• To identify pre-operative factors associated with on-table extubation (OTE).
• To assess the impact of OTE on intensive care unit length of stay (ICU LOS) and reintubation rates.

Main Methods:

• A cohort study of adult first-time liver-only transplant recipients.
• Primary outcome: on-table extubation (OTE).
• Multivariable logistic regression used to create a predictive score for OTE.

Main Results:

• 32.9% of patients achieved OTE; only 1.9% required reintubation within 48 hours.
• OTE significantly decreased ICU LOS by approximately 60%.
• Predictors of lower OTE odds included higher MELD score, prior abdominal surgery, and elevated donor bilirubin; normothermic machine perfusion increased OTE odds.

Conclusions:

• Early extubation following liver transplantation is safe and reduces ICU length of stay.
• A predictive model incorporating pre-operative factors can identify patients suitable for early extubation.
• This model is a foundational step towards protocols enabling patients to bypass intensive care post-transplant.