*Purpose: Historically, liver transplant (LT) patients have been admitted directly from the operating room (OR) to the intensive care unit (ICU) for post-operative complex hemodynamic and respiratory monitoring. For nearly two decades, our institution has utilized a fast-track program in which select LT patients are extubated in the OR and admitted to the post anesthesia care unit (PACU) followed by subsequent admission to the medical ward. Those patients who require intraoperative continuous renal replacement therapy (CRRT), diagnosed with Hepatopulmonary Syndrome (HPS) or Porto-pulmonary Hypertension (PoPH) are automatically transferred to ICU post-operatively. Here we describe the profile of our LT patients admitted directly to the ICU from the OR post-LT over the past year.

*Methods: A review of the electronic medical record was performed for all liver transplant patients who were admitted to the ICU post-operatively from October 1, 2019 to October 1, 2020.

*Results: During the above timeframe, 113 adult deceased donor LTs were performed, 78 (69%) of which were admitted to the ICU post-operatively. Of those admitted to the ICU, 11 received simultaneous liver-kidney transplants, 1 received a simultaneous liver-heart transplant, and 6 received simultaneous LT and sleeve gastrectomy. Of the remaining 60 LT cases, the top three reasons for post-operative admission to the ICU included: post-operative vasopressor requirements or hemodynamic instability in 44 (73.3%) cases, intra-operative continuous renal replacement therapy (CRRT) in 17 (28.3%) cases, and pre-operative ICU admission in 11 (18.3%) cases. Alternative reasons for OR to ICU transfer included: intra-operative bleeding (6, 10%), reintubation or inability to extubate (3, 5%), intra-operative cardiac arrest (2, 3.3%), HPS(2, 3.3%), PoPH (1, 1.7%), and uncontrolled hypertension (1, 1.7%). The majority of OR to ICU cases received donations by brain death (51, 85%) with an average intra-operative transfusion requirement of 8.75 units of red blood cells (median 8 units).

*Conclusions: We aimed to understand those defining patient characteristics which required admission to the ICU to better understand if there are modifiable risk factors to minimize ICU admissions with the goal of better utilizing ICU beds during the COVID 19 pandemic. Further research is necessary to determine safety in moving those patients with intraoperative CRRT to the floor rather than an automatic ICU admission.

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