Immediate Extubation Following Pediatric Liver Transplantation: A Single Center Experience
Surgery and Anesthesia, Boston Children's Hospital, Boston, MA
Meeting: 2013 American Transplant Congress
Abstract number: 56
Purpose
Care of pediatric liver transplant recipients has traditionally included postoperative ventilation. Since 2005, we have evaluated for immediate extubation(IE) in the operating room based on standard criteria used for general surgery cases. We review our institution's experience to determine which factors were associated with IE.
Methods
We performed a retrospective review of 84 children who underwent liver transplantation from 2005-2011 and stratified based on whether or not they underwent IE. Categorical data were analyzed using exact tests, normally distributed data using t-tests, and nonparametric data using rank-sum tests.
Results
51% of all patients underwent IE. The IE rate increased to 70% during 2009-2011 from 37% during 2005-2008. Patients undergoing IE had lower MELD/PELD scores, less commonly had parenteral nutrition associated liver disease, and were more likely to be isolated liver recipients. Lower volumes of intraoperatively administered PRBC, FFP, and platelets were each associated with IE. There was no difference in reintubation rates between groups. Patients undergoing IE had shorter mean ICU and overall hospital lengths of stay.
| Characteristic | Immediate Extubation | P value | |
| No(n=41) | Yes(n=43) | ||
| Transplant Year | 0.002 | ||
| 2005-2008 | 26 (63.4) | 13 (30.2) | |
| 2009-2011 | 15(36.6) | 30(69.8) | |
| Age,yrs,median,IQR | 1.7(0.6-7.0) | 1.9(0.7-8.4) | 0.53 |
| Recipient weight,kg,median,IQR | 9.6(6.4-23.6) | 11.8(7.1-24.0) | 0.29 |
| Diagnosis | 0.01 | ||
| Atresia | 15(36.6) | 15(40.5) | |
| Cirrhosis | 4(9.8) | 2(5.4) | |
| Malignancy | 5(12.2) | 6(16.2) | |
| Metabolic | 5(12.2) | 7(18.9) | |
| Other | 3(7.2) | 7(18.9) | |
| PN related | 9(22.0) | 0(0) | |
| M/P at listing,N,(%) | 0.01 | ||
| ≤10 | 11(26.8) | 24(56.1) | |
| 11-29 | 14(34.2) | 13(30.2) | |
| ≥30 or Status 1 | 16(39.0) | 6(14.0) | |
| ICU Pre-op,N,(%) | 9(22.0) | 3(7.0) | 0.06 |
| Graft | 0.002 | ||
| Whole | 9(22.0) | 20(46.5) | |
| Living | 0(0) | 2(4.6) | |
| Split | 18(43.9) | 18(41.9) | |
| Multivisceral | 14(34.2) | 3(7.0) | <
To cite this abstract in AMA style: Fullington N, Cauley R, Potanos K, Seefelder C, Kim H, Vakili K. Immediate Extubation Following Pediatric Liver Transplantation: A Single Center Experience [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/immediate-extubation-following-pediatric-liver-transplantation-a-single-center-experience/. Accessed November 22, 2024.« Back to 2013 American Transplant Congress |