Observations with impact on the indication for kinetic therapy in critically ill liver transplant patients.
BACKGROUND
Severe pulmonary complications following orthotopic liver transplantation are a major cause of postoperative deaths. Kinetic therapy (KT) has been reported to prevent and treat respiratory complications in selected critically ill patients, but little has been reported about the value of different criteria for the use of this therapy and its side effects in liver transplant recipients.


METHODS
We performed a prospective observational study of 27 patients treated post-transplantation in our ICU. 12 of 27 patients were treated with KT in case of either high number of blood transfusions (>20) or respiratory insufficiency (PaO2/FiO2 ratio <250 mmHg) or pretransplant pulmonary disease. Over a period of nine days we measured the PaO2/FiO2 ratio to evaluate the beneficial effect of KT. Liver perfusion was quantified by doppler ultrasound. Transplant function was measured by INR (international normalised ratio) and determination of indocyanine green elimination rate.


RESULTS
Side effects on graft perfusion and graft function were not seen. 7 of 12 patients decreased in their PaO2/FiO2 ratio significantly 48 hours postoperative to 53% as compared to early postoperative level and recovered under KT during the observed time period nearly to the early postoperative level (95%; p<0.001). The units of perioperative blood transfusions, the MELD-score, the decrease of PaO2/FiO2 ratio 24 h after transplantation and retransplantation for initial non-functioning of the graft all pointed to a likely beneficial effect of KT.


CONCLUSIONS
We conclude that these criteria may be helpful to identify patients who are likely to benefit from KT.
Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-St. 1, Hannover, Germany. Kleine.Moritz@mh-hannover.de
Moritz
M
Kleine
Kai
K
Joahnning
Lampros
L
Kousoulas
Harald
H
Schrem
Frank
F
Lehner
Hüseyin
H
Bektas
Jürgen
J
Klempnauer
Stephan
S
Kaaden
D000328:Adult; D016638:Critical Illness / Q000628:therapy; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D012138:Respiratory Therapy / Q000379:methods; D012307:Risk Factors; D012399:Rotation