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eISSN: 2329-0358

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Annals of Transplantation is one of the fast-developing journals open to all scientists and fields of transplant medicine and related research. The journal is published quarterly and provides extensive coverage of the most important advances in transplantation.
Using an electronic on-line submission and peer review tracking system, Annals of Transplantation is committed to rapid review and publication. The average time... read more


Published: 2020-08-11

Tracheostomy Post Liver Transplant: Predictors, Complications, and Outcomes

Ryan C. Graham, Weston J. Bush, Jeffrey S. Mella, Jonathan A. Fridell, Burcin Ekser, Plamen Mihaylov, Chandrashekhar A. Kubal, Richard S. Mangus

(Department of Anesthesia, University of Utah, Salt Lake City, UT, USA)

Ann Transplant 2020; 25:e920630

DOI: 10.12659/AOT.920630


BACKGROUND: Liver transplant (LT) patients have an increased risk of postoperative respiratory failure requiring tracheostomy. This study sought to characterize objective clinical predictors of tracheostomy.
MATERIAL AND METHODS: The records for 2017 LT patients at a single institution were reviewed. Patients requiring tracheostomy were first compared with all other patients. A case-control subgroup analysis was conducted in which 98 tracheostomy patients were matched with 98 non-tracheostomy LT patients. For the case-control study, muscle mass was assessed using preoperative computed tomography scans.
RESULTS: Among 2017 LT patients, 98 required tracheostomy (5%), with a 19% complication rate. Tracheostomy patients were older and had a higher model for end-stage liver disease score, a lower body mass index (BMI), and a greater smoking history. Tracheostomy patients had a longer hospital stay (45 vs. 10 days, P<0.001) and worse 1-year survival (65% vs. 91%, P<0.001). Ten-year Cox regression patient survival for tracheostomy patients was significantly worse (32% vs. 68%, P<0.001). In the case-control analysis, respiratory failure patients were older (P<0.01) and had a lower BMI (P=0.05). They also had a muscle mass deficit of -39% compared with matched LT controls (P<0.001). No significant differences were seen with pre-LT total protein or albumin or with forced expiratory volume in 1 s divided by forced vital capacity (FEV1/FVC) values.
CONCLUSIONS: Predictors for respiratory failure requiring post-LT tracheostomy include higher model for end-stage liver disease score, older age, lower BMI, greater smoking history, and worse sarcopenia. Patients requiring tracheostomy have dramatically longer hospital stays and worse survival.

Keywords: Frail Elderly, Liver Transplantation, malnutrition, Postoperative Complications, Respiration, Artificial, Tracheostomy



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