title: Late Intensive Care Unit Admission in Liver Transplant Recipients: 10-Year Experience.
abstract: OBJECTIVE
  We evaluated late intensive care unit admission in liver transplant recipients to identify incidences and causes of acute respiratory failure in the postoperative period and to compare these results with results in patients who did not have acute respiratory failure.
  
  
  METHODS
  We retrospectively screened the data of 173 consecutive adult liver transplant recipients from January 2005 through March 2015 to identify patients with late admission (> 30 d posttransplant) to an intensive care unit. Patients were divided into 2 groups: patients with and without acute respiratory failure. Acute respiratory failure was defined as severe dyspnea, respiratory distress, decreased oxygen saturation, hypoxemia or hypercapnia on room air, or need for noninvasive or invasive mechanical ventilation. Demographic, laboratory, clinical, and respiratory data were collected. Model for End-Stage Liver Disease, Acute Physiology and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores; lengths of intensive care unit and hospital stays; and hospital mortality were assessed.
  
  
  RESULTS
  Among 173 patients, 37 (21.4%) were admitted to an intensive care unit, including 22 (59.5%) with acute respiratory failure. The leading cause of acute respiratory failure was pneumonia (n = 19, 86.4%). Patients with acute respiratory failure had significantly lower levels of albumin before intensive care unit admission (P = .003). In patients with acute respiratory failure, severe sepsis and septic shock were more frequently observed and tracheotomy was more frequently performed (P = .041).
  
  
  CONCLUSIONS
  Acute respiratory failure developed in 59.5% of liver transplant recipients with late intensive care unit admission. The leading cause was pneumonia, with this group of patients having higher requirements for invasive mechanical ventilation and tracheotomy, longer stays in an intensive care unit, and higher mortality.
authors.affiliation: From the Department of Anesthesiology and Reanimation, Başkent University Faculty of Medicine, Ankara, Turkey.
authors.forename: Funda
authors.initials: F
authors.lastname: Atar
authors.forename: Ender
authors.initials: E
authors.lastname: Gedik
authors.forename: Şerife
authors.initials: Ş
authors.lastname: Kaplan
authors.forename: Pınar
authors.initials: P
authors.lastname: Zeyneloğlu
authors.forename: Arash
authors.initials: A
authors.lastname: Pirat
authors.forename: Mehmet
authors.initials: M
authors.lastname: Haberal
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011014:Pneumonia / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014139:Tracheostomy; D066027:Transplant Recipients; D016896:Treatment Outcome