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 [PMID: 23383363 DOI: 10.4254/wjh.v5.i1.26]
Corresponding Author of This Article
Lena Sibulesky, MD, Department of Transplantation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United States. sibulesky.lena@mayo.edu
Article-Type of This Article
Original Article
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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
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%)
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%)
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
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