Outcomes following liver transplantation in intensive care unit patients

doi:10.4254/wjh.v5.i1.26

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Jan 27, 2013 (publication date) through Apr 18, 2024

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Hepatol. Jan 27, 2013; 5(1): 26-32
Published online Jan 27, 2013. doi: 10.4254/wjh.v5.i1.26

Table 1 Patient, operative and donor characteristics in intensive care unit and non-intensive care unit patients

Variable	ICU patients(n = 39)	Non-ICU patients(n = 927)	P value
Patient characteristics
Age at transplant	57 (33-74)	57 (16-77)	0.91
Gender (male)	21 (54%)	653 (70%)	0.033
BMI	25.7 (18.0-38.0)	28.4 (16.4-61.1)	0.091
Diagnosis
Hepatitis C	18 (46%)	364 (41%)	0.41
ETOH	10 (26%)	138 (15%)	0.11
Cryptogenic cirrhosis	8 (21%)	147 (16%)	0.5
NASH	0 (0%)	76 (8%)	0.066
PSC	0 (0%)	61 (7%)	0.17
Other	3 (8%)	141 (15%)	0.25
MELD at transplant	37 (24-50)	20 (6-45)	< 0.001
Previous operation	13 (34%)	402 (47%)	0.13
Operative characteristics
Operative time (min)	230 (129-596)	231 (100-745)	0.69
Blood transfusion (mL)	3850 (1400-15 400)	2800 (0-44 100)	0.002
Cold ischemia time (h)	6.3 (3.4-10.4)	6.3 (2.0-14.0)	0.71
Warm ischemia time (min)	30 (18-84)	31 (10-141)	0.59
Donor characteristics
Age	42 (8-78)	48 (7-88)	0.016
Gender (male)	17 (46%)	551 (59%)	0.12
Recipient-donor gender incompatibility	15 (41%)	348 (38%)	0.73
Donation after cardiac death	6 (16%)	146 (16%)	1.00
Donor risk index	1.53 (0.88-2.60)	1.66 (0.85-4.30)	0.085

The sample median (minimum-maximum) is given for numerical variables. P values result from Fisher’s exact test or a Wilcoxon rank sum test. Information was unavailable regarding previous operations (ICU: n = 1; non-ICU: n = 80), operative time (ICU: n = 2; non-ICU: n = 1), blood transfusion (ICU: n = 3; non-ICU: n = 13), cold ischemia time (ICU: n = 2), warm ischemia time (ICU: n = 2), and all donor characteristics (ICU: n = 2). ICU: Intensive care unit; BMI: Body mass index; ETOH: Ethanol; NASH: Nonalcoholic steatohepatitis; PSC: Primary sclerosing cholangitis; MELD: Model for end-stage liver disease.

Table 2 Additional information for intensive care unit patients only

Variable	Summary(n = 39)
Patient characteristics
Vasopressors	14 (36%)
Vasopressin	12 (31%)
Dose (units/min)	0.04 (0.01-0.04)
Norepinephrine	8 (21%)
Dose (mcg/kg per min)	0.07 (0.01-0.18)
Vasopressin and norepinephrine	6 (15%)
Length of time from hospital admission to ICU admission (d)	3 (1-32)
Length of time from ICU admission to liver transplant (d)	12 (1-65)
MELD at ICU admission	32 (15-52)
MELD at transplant	37 (24-50)
Pre-transplant ambulation	14 (42%)
Dialysis	25 (64%)
Tracheostomy	9 (23%)
Mechanical ventilation	16 (41%)
Positive end-expiratory pressure (cm H₂0)	7 (7-12)
FiO₂ (%)	40 (28-60)
Mean airway pressure (cm H₂0)	12 ( 9-18)
PaO₂ (mmHg)	103 (60-147)
Post-operative characteristics
Post-operatively placed tracheostomy	4 (10%)
Length of hospital stay	42 (15-516)
Length of ICU stay	27 (7-327)
Discharged status
Home	19 (49%)
Rehab	14 (36%)
Death	6 (15%)
3-mo readmission	16 (41%)

The sample median (minimum-maximum) is given for numerical variables. Information regarding positive end-expiratory pressure, FiO₂, mean airway pressure, and PaO₂ were only available for patients with mechanical ventilation. Information was unavailable regarding ambulation (n = 5), mean airway pressure (n = 2), and PaO₂ (n = 1). ICU: Intensive care unit; MELD: Model for end-stage liver disease.

Table 3 Graft survival and patient survival in intensive care unit patients and non- intensive care unit patients

	Estimate (95%CI)
Outcome/time since transplant	ICU patients(n = 39)	Non-ICU patients(n = 927)
Graft survival
1 yr	76% (62%-91%)	90% (88%-92%)
2 yr	72% (58%-89%)	84% (82%-87%)
3 yr	68% (52%-86%)	81% (78%-83%)
4 yr	62% (44%-83%)	78% (75%-81%)
5 yr	62% (41%-83%)	75% (72%-78%)
Patient survival
1 yr	78% (65%-93%)	94% (92%-95%)
2 yr	75% (61%-91%)	89% (87%-91%)
3 yr	70% (55%-88%)	85% (83%-87%)
4 yr	65% (47%-86%)	82% (79%-84%)
5 yr	65% (43%-86%)	79% (76%-82%)

ICU: Intensive care unit.

Table 4 Associations of patient and donor characteristics with graft survival (graft loss or death endpoint) and patient survival (death endpoint) in intensive care unit patients

	Association with graft survival (graft loss or death endpoint)		Association with patient survival (death endpoint)
Variable	Relative risk (95%CI)	P value	Relative risk (95%CI)	P value
Patient characteristics
Age at transplant (10 yr increase)	0.98 (0.49-1.99)	0.96	1.00 (0.47-2.11)	0.99
Gender (male)	1.33 (0.42-4.19)	0.63	1.10 (0.34-3.61)	0.88
BMI (10 unit increase)	0.63 (0.24-1.66)	0.35	0.57 (0.20-1.59)	0.28
Diagnosis
Hepatitis C	0.99 (0.32-3.08)	0.99	0.79 (0.24-2.59)	0.69
ETOH	0.57 (0.12-2.59)	0.46	0.65 (0.14-3.02)	0.58
Cryptogenic cirrhosis	3.29 (0.97-11.15)	0.056	3.97 (1.14-13.87)	0.031
MELD at transplant (5 unit increase)	0.99 (0.63-1.57)	0.97	1.09 (0.68-1.75)	0.72
MELD at ICU admission (5 unit increase)	0.85 (0.56-1.30)	0.47	1.03 (0.66-1.61)	0.89
Previous operation	1.07 (0.31-3.67)	0.91	0.76 (0.20-2.95)	0.69
Vasopressors	1.06 (0.32-3.51)	0.93	1.24 (0.36-4.23)	0.74
Vasopressin	0.78 (0.23-2.59)	0.68	0.91 (0.27-3.11)	0.88
Norepinephrine	0.29 (0.04-2.22)	0.23	0.32 (0.04-2.51)	0.28
Vasopressin and norepinephrine	0.44 (0.06-3.44)	0.44	0.50 (0.06-3.90)	0.51
Length of time from hospital admission to ICU admission (doubling)	0.91 (0.64-1.28)	0.57	0.88 (0.61-1.27)	0.49
Ambulation	1.30 (0.36-4.72)	0.69	1.30 (0.36-4.72)	0.69
Dialysis	1.70 (0.46-6.32)	0.43	1.46 (0.38-5.54)	0.58
Tracheostomy	1.00 (0.27-3.71)	1.00	0.61 (0.13-2.83)	0.53
Mechanical ventilation	0.91 (0.29-2.88)	0.88	0.69 (0.20-2.37)	0.56
Donor characteristics
Age (10 yr increase)	0.97 (0.67-1.41)	0.88	0.91 (0.61-1.36)	0.65
Gender (male)	0.74 (0.21-2.63)	0.64	0.52 (0.13-2.09)	0.36
Recipient-donor gender incompatibility	1.33 (0.36-4.91)	0.67	1.76 (0.45-6.87)	0.41
Donation after cardiac death	3.38 (0.95-12.05)	0.060	4.19 (1.12-15.70)	0.033
Donor risk index (1 unit increase)	2.15 (0.54-8.62)	0.28	1.61 (0.36-7.15)	0.53

Relative risks and P values result from single variables Cox proportional hazards regression models. Relative risks correspond to presence of the given characteristic (categorical variables) or the increase given in parenthesis (numerical variables). A higher relative risk indicates an increased likelihood of experiencing the given endpoint. ICU: Intensive care unit; BMI: Body mass index; ETOH: Ethanol; MELD: Model for end-stage liver disease..

Citation: Sibulesky L, Heckman MG, Taner CB, Canabal JM, Diehl NN, Perry DK, Willingham DL, Pungpapong S, Rosser BG, Kramer DJ, Nguyen JH. Outcomes following liver transplantation in intensive care unit patients. World J Hepatol 2013; 5(1): 26-32
URL: https://www.wjgnet.com/1948-5182/full/v5/i1/26.htm
DOI: https://dx.doi.org/10.4254/wjh.v5.i1.26