title: Is a mandatory intensive care unit stay needed after liver transplantation? Feasibility of fast-tracking to the surgical ward after liver transplantation.
abstract: The continuation of hemodynamic, respiratory, and metabolic support for a variable period after liver transplantation (LT) in the intensive care unit (ICU) is considered routine by many transplant programs. However, some LT recipients may be liberated from mechanical ventilation shortly after the discontinuation of anesthesia. These patients might be appropriately discharged from the postanesthesia care unit (PACU) to the surgical ward and bypass the ICU entirely. In 2002, our program started a fast-tracking program: select LT recipients are transferred from the operating room to the PACU for recovery and tracheal extubation with a subsequent transfer to the ward, and the ICU stay is completely eliminated. Between January 1, 2003 and December 31, 2007, 1045 patients underwent LT at our transplant program; 175 patients were excluded from the study. Five hundred twenty-three of the remaining 870 patients (60.10%) were fast-tracked to the surgical ward, and 347 (39.90%) were admitted to the ICU after LT. The failure rate after fast-tracking to the surgical ward was 1.90%. The groups were significantly different with respect to the recipient age, the raw Model for End-Stage Liver Disease (MELD) score at the time of LT, the recipient body mass index (BMI), the retransplantation status, the operative time, the warm ischemia time, and the intraoperative transfusion requirements. A multivariate logistic regression analysis revealed that the raw MELD score at the time of LT, the operative time, the intraoperative transfusion requirements, the recipient age, the recipient BMI, and the absence of hepatocellular cancer/cholangiocarcinoma were significant predictors of ICU admission. In conclusion, we are reporting the largest single-center experience demonstrating the feasibility of bypassing an ICU stay after LT.
authors.affiliation: Department of Transplantation, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA. taner.burcin@mayo.edu
authors.forename: C Burcin
authors.initials: CB
authors.lastname: Taner
authors.forename: Darrin L
authors.initials: DL
authors.lastname: Willingham
authors.forename: Ilynn G
authors.initials: IG
authors.lastname: Bulatao
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Shine
authors.forename: Prith
authors.initials: P
authors.lastname: Peiris
authors.forename: Klaus D
authors.initials: KD
authors.lastname: Torp
authors.forename: Juan
authors.initials: J
authors.lastname: Canabal
authors.forename: Justin H
authors.initials: JH
authors.lastname: Nguyen
authors.forename: David J
authors.initials: DJ
authors.lastname: Kramer
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D007362:Intensive Care Units; D016031:Liver Transplantation / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index