Predictive score for immediate extubation after liver transplantation

Abstract

Introduction: Evidence suggests that immediate extubation after liver transplantation provides graft and economic benefits without compromising patient outcomes. This study tried to determine the incidence of immediate extubation, demonstrate related factors, and develop a predictive model from the significant factors.

Methods: This retrospective descriptive study included 240 out of 271 liver transplantation patients in the hospital liver transplant registry between 2004 and 2016. Extubated and non-extubated groups were statistically compared.

Results: The incidence of immediate extubation was 32.1%. It was associated with a MELD score ≤ 25 (adjusted OR, 5.17; 95% CI, 1.64-16.24; p = .005); packed red cells (PRC) transfusion ≤1600 ml (adjusted OR, 3.45; 95% CI, 1.82-6.53; p < .001); and no requirement for post-operative vasopressors (adjusted OR, 5.83; 95% CI, 2.30-14.77; p < .001). The immediate-extubation group had fewer complications and shorter hospital stays. A Siriraj Liver transplant Extubation Score (SLES) of 5 yielded the best prediction of safe immediate extubation.

Conclusions: An incidence of 32.1% was found for immediate extubation following liver transplantation. Associated factors were a MELD score ≤ 25, a lower amount of transfused blood, and no requirement for post-operative vasopressors. An SLES score of 5 predicted safe immediate extubation.

Keywords: extubation; liver transplantation; predictive score; risk factors.