title: Pretransplant Factors and Associations with Postoperative Respiratory Failure, ICU Length of Stay, and Short-Term Survival after Liver Transplantation in a High MELD Population.
abstract: Changes in distribution policies have increased median MELD at transplant with recipients requiring increasing intensive care perioperatively. We aimed to evaluate association of preoperative variables with postoperative respiratory failure (PRF)/increased intensive care unit length of stay (ICU LOS)/short-term survival in a high MELD cohort undergoing liver transplant (LT). Retrospective analysis identified cases of PRF and increased ICU LOS with recipient, donor, and surgical variables examined. Variables were entered into regression with end points of PRF and ICU LOS > 3 days. 164 recipients were examined: 41 (25.0%) experienced PRF and 74 (45.1%) prolonged ICU LOS. Significant predictors of PRF with univariate analysis: BMI > 30, pretransplant MELD, preoperative respiratory failure, LVEF < 50%, FVC < 80%, intraoperative transfusion > 6 units, warm ischemic time > 4 minutes, and cold ischemic time > 240 minutes. On multivariate analysis, only pretransplant MELD predicted PRF (OR 1.14,p= 0.01). Significant predictors of prolonged ICU LOS with univariate analysis are as follows: pretransplant MELD, FVC < 80%, FEV1 < 80%, deceased donor, and cold ischemic time > 240 minutes. On multivariate analysis, only pretransplant MELD predicted prolonged ICU LOS (OR 1.28,p< 0.001). One-year survival among cohorts with PRF and increased ICU LOS was similar to subjects without. Pretransplant MELD is a robust predictor of PRF and ICU LOS. Higher MELDs at LT are expected to increase need for ICU utilization and modify expectations for recovery in the immediate postoperative period.
authors.affiliation: Department of Internal Medicine, Banner University Medical Center, University of Arizona College of Medicine, Phoenix, AZ, USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Pedersen
authors.affiliation: Arizona State University College of Nursing and Health Care Innovation, Phoenix, AZ, USA.
authors.forename: Myunghan
authors.initials: M
authors.lastname: Choi
authors.affiliation: Arizona Transplant Associates, Phoenix, AZ, USA; Banner Transplant and Advanced Liver Disease Center, University of Arizona College of Medicine, Phoenix, AZ, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Brink
authors.affiliation: Banner Transplant and Advanced Liver Disease Center, University of Arizona College of Medicine, Phoenix, AZ, USA; Division of Gastroenterology, Banner University Medical Center, University of Arizona College of Medicine, Phoenix, AZ, USA.
authors.forename: Anil B
authors.identifier: 0000-0001-7090-3035
authors.initials: AB
authors.lastname: Seetharam