title: Prognostic impact of mechanical ventilation after liver transplantation: a national database study.
abstract: BACKGROUND
  The impact of mechanical ventilatory support (MCVS) on mortality and graft loss after liver transplantation (LT) is not well described.
  
  
  METHODS
  Multivariate analysis of a novel database linking national transplant registry and Medicare claims data was used to assess the impact of early MCVS on mortality and graft survival following LTs performed between 2002 and 2008.
  
  
  RESULTS
  Among 10,517 LT recipients, 6.9% (n = 726) required postoperative MCVS, 25.6% of whom required less than 96 hours, 24.2% required 96 hours or longer, and 50.1% received an unspecified duration. Significant predictors of prolonged MCVS included older age, female sex, pretransplant dialysis requirement, and ascites. After multivariate adjustment, MCVS of 96 hours or longer was associated with nearly 3 times the adjusted hazard ratio of mortality (2.95, P < .001), while MCVS less than 96 hours was not significantly associated with mortality (adjusted hazard ratio .88, P = .55).
  
  
  CONCLUSIONS
  Recognition of LT patients at risk for prolonged MCVS may help to reduce the incidence and consequences of this complication.
authors.affiliation: Department of Anesthesia, Saint Louis University School of Medicine, St. Louis, MO, USA.
authors.forename: Hui
authors.initials: H
authors.lastname: Yuan
authors.affiliation: Department of Anesthesia, Saint Louis University School of Medicine, St. Louis, MO, USA; Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Tuttle-Newhall
authors.affiliation: Department of Anesthesia, Saint Louis University School of Medicine, St. Louis, MO, USA.
authors.forename: Vikram
authors.initials: V
authors.lastname: Chawa
authors.affiliation: Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA; Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
authors.affiliation: Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA.
authors.forename: Huiling
authors.initials: H
authors.lastname: Xiao
authors.affiliation: Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH, USA.
authors.forename: David
authors.initials: D
authors.lastname: Axelrod
authors.affiliation: Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH, USA.
authors.forename: Nino
authors.initials: N
authors.lastname: Dzebisashvili
authors.affiliation: Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA; Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH, USA. Electronic address: lentinek@slu.edu.
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000628:therapy*; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011379:Prognosis; D012042:Registries; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Graft failure; Liver transplantation; Mechanical ventilation; Medicare; Mortality