*Purpose: Early extubation (either intraoperative or within 6 hours post operatively) is an important component of enhanced recovery pathways. The goal of the study was to determine predictors of early extubation following liver transplantation (LTx)

*Methods: Retrospective analysis of adult LTx performed at our institution between 1/1/2020 and 12/31/2020. Pre-operative, intraoperative and early post operative data was collected. Statistical analysis multivariate analysis were performed.

*Results: 151 LTx recipients were included in the study. 52 patients (37.4%) were either extubated in the operating room (6.6%) or within 6 hours (27.8%). Patients who were extubated early had significantly lower MELD scores (25 vs 28, p=0.003), more likely to have come in for transplant from home (69% vs 43%, p=0.004) and non smokers (55.8% vs 32.3, p=0.004). Intraoperatively, patients who were extubated early had significantly less operative time, lower blood loss and transfusions, lower peak lactate (4.2 vs 5.6, p=0.001). There were likely to be closer to normothermia, and not on pressors during the last hour of surgery. On multivariate models – lower peak lactate (HR 1.316, p=0.05), lower PRBC use (HR 1.304, p <0.001) were associated with early extubation. Early extubation did not result in higher re-intubation or post operative complication rates. It was associated with significantly lower ICU length of stay (p=.004).

*Conclusions: Early extubation after LTx is feasible safely in appropriately selected candidates. This results in significantly lower ICU length of stay and is a critical component of enhanced recovery after LTx.

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