Intraoperative predictors of early tracheal extubation after living-donor liver transplantation / 대한마취과학회지

BACKGROUND: Prolonged mechanical ventilation after liver transplantation has been associated with deleterious clinical outcomes, so early tracheal extubation posttransplant is now increasing. However, there is no universal clinical criterion for predicting early extubation in living-donor liver transplantation (LDLT). We investigated specific predictors of early extubation after LDLT. METHODS: Perioperative data of adult patients undergoing LDLT were reviewed. "Early" extubation was defined as tracheal extubation in the operating room or intensive care unit (ICU) within 1 h posttransplant, and we divided patients into early extubation (EX) and non-EX groups. Potentially significant (P < 0.10) perioperative variables from univariate analyses were entered into multivariate logistic regression analyses. Individual cut-offs of the predictors were calculated by area under the receiver operating characteristic curve (AUC) analysis. RESULTS: Of 107 patients, 66 (61.7%) were extubated early after LDLT. Patients in the EX group showed shorter stays in the hospital and ICU and lower incidences of reoperation, infection, and vascular thrombosis. Preoperatively, model for end-stage liver disease score, lung disease, hepatic encephalopathy, ascites, and intraoperatively, surgical time, transfusion of packed red blood cell (PRBC), urine output, vasopressors, and last measured serum lactate were associated with early extubation (P < 0.05). After multivariate analysis, only PRBC transfusion of < or = 7.0 units and last serum lactate of < or = 8.2 mmol/L were selected as predictors of early extubation after LDLT (AUC 0.865). CONCLUSIONS: Intraoperative serum lactate and blood transfusion were predictors of posttransplant early extubation. Aggressive efforts to ameliorate intraoperative circulatory issues would facilitate successful early extubation after LDLT.

Relationship of preoperative echocardiography and circulation in living donor liver transplantation

BACKGROUND: Echocardiography has been routinely performed before liver transplantation to screen perioperative risks due to cardiovascular complications. However, only limited echocardiographic indices have been used and have become familiar with clinicians. Here we aimed to evaluate the relationship between preoperative echocardiography and circulatory manifestations during living donor liver transplantation (LDLT). METHODS: Perioperative data including preoperative echocardiographic indices and intraoperative circulatory manifestations from 159 LDLT recipients (> or =18 years) were retrospectively collected. Relationships between individual echocardiographic indices and intraoperative circulatory manifestations were assessed by Pearson or Spearman correlation test. Intraoperative circulatory manifestations showing potential correlation with echocardiographic indices (r > or = 0.2 or or = 0.5 or < or =-0.5) were not found between echocardiographic indices and intraoperative circulatory manifestations, but intensive vasopressor coverage, urine output, sodium bicarbonate administration and last blood pH showed potential relations with at least one of preoperative echocardiographic indices. Early and late (atrial) ventricular filling velocity (E/A) ratios were lower in recipients with intensive vasopressor coverage, and left atrial diameter (LAD) were larger in recipients with last blood pH < 7.25. However, other parts of echocardiographic indices showed inconsistent relationships with formerly prevalent knowledge. CONCLUSIONS: Preoperative echocardiographic indices such as E/A ratio and LAD showed relationship with circulatory manifestations during LDLT. However, low correlation degrees and lack of evidence in reverse relationship with circulatory manifestations demands further studies focusing on such specific cardiac function.