Relevant clinical factors for early extubation in living-donor liver transplantation: A single-center retrospective cohort study

doi:10.12998/wjcc.v13.i14.102693

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World Journal of Clinical Cases

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Retrospective Cohort Study

World J Clin Cases. May 16, 2025; 13(14): 102693
Published online May 16, 2025. doi: 10.12998/wjcc.v13.i14.102693

Table 1 Comparison of preoperative characteristics between the delayed and early extubation group, n (%)

Variables	Whole group (n = 159)			Subgroup (n = 67)
Variables	Delayed extubation (n = 66)	Early extubation (n = 93)	P value	Delayed extubation (n = 20)	Early extubation (n = 47)	P value
Age (year)	53.4 (8.2)	54.9 (7.5)	0.246	55.1 (7.1)	55.0 (8.2)	0.965
Sex (male)	49 (74.2)	70 (75.3)	> 0.999	16 (80.0)	39 (83.0)	0.741
ASA	-	-	0.163	-	-	0.527
II	18 (27.3)	14 (15.1)	-	7 (35.0)	12 (25.5)	-
III	39 (59.1)	65 (69.9)	-	12 (60.0)	29 (61.7)	-
IV	9 (13.6)	14 (15.1)	-	1 (5.0)	6 (12.8)	-
Height (cm)	165.9 (8.2)	165.5 (7.9)	0.755	166.4 (8.9)	165.7 (7.3)	0.752
Weight (kg)	64.7 (12.5)	63.3 (10.5)	0.439	66.1 (11.0)	64.4 (9.1)	0.499
BMI (kg/m²)	23.4 (3.4)	23.0 (2.7)	0.430	23.8 (3.0)	23.4 (2.4)	0.528
Malnutrition (BMI < 18.5)	5 (7.6)	8 (8.6)	> 0.999	0 (0.0)	2 (4.3)	> 0.999
Obesity (BMI > 30)	3 (4.5)	1 (1.1)	0.308	1 (5.0)	1 (2.1)	0.511
Etiology
Viral	43 (65.2)	71 (76.3)	0.172	13 (65.0)	39 (83.0)	0.121
Alcoholic	20 (30.3)	19 (20.4)	0.215	4 (20.0)	6 (12.8)	0.470
Malignancy	40 (60.6)	59 (63.4)	0.844	16 (80.0)	35 (74.5)	0.760
Autoimmune	1 (1.5)	1 (1.1)	> 0.999	1 (5.0)	0 (0.0)	0.299
Others	4 (6.1)	5 (5.4)	> 0.999	1 (5.0)	2 (4.3)	> 0.999
MELD score	15.0 (7.0-23.0)	10.0 (8.0-16.0)	0.113	7.5 (7.0-11.8)	8.0 (7.0-10.0)	0.418
Functional capacity ≥ 4 METs	24 (36.4)	38 (40.9)	0.683	12 (60.0)	23 (48.9)	0.574
Preoperative cardiac echo findings
LVEF (%)	67.0 (63.0-70.3)	66.0 (63.3-69.0)	0.515	64.5 (62.3-68.5)	67.0 (64.0-69.3)	0.149
Pulmonary hypertension	4 (6.1)	4 (4.4)	0.721	0 (0.0)	1 (2.1)	> 0.999
Comorbidity
Preoperative RRT	4 (6.1)	2 (2.2)	0.234	1 (5.0)	0 (0.0)	0.299
Hypertension	11 (16.7)	19 (20.4)	0.695	5 (25.0)	12 (25.5)	> 0.999
Diabetes mellitus	18 (27.3)	35 (37.6)	0.232	5 (25.0)	13 (27.7)	> 0.999
Cerebro-cardiovascular disease	0 (0.0)	2 (2.2)	0.511	0 (0.0)	1 (2.1)	> 0.999
Preoperative delirium	8 (12.1)	2 (2.2)	0.017	0 (0.0)	0 (0.0)	N/A
Hepatopulmonary syndrome	11 (16.7)	13 (14.0)	0.854	2 (10.0)	4 (8.7)	> 0.999
West-Haven criteria on encephalopathy	-	-	0.234	-	-	> 0.999
Grade 0-1	62 (93.9)	91 (97.8)	-	20 (100.0)	46 (97.9)	-
Grade 2	4 (6.1)	2 (2.2)	-	0 (0.0)	1 (2.1)	-
Grade 3-4	0 (0.0)	0 (0.0)	-	0 (0.0)	0 (0.0)	-
Baseline laboratory findings
PaO₂/FiO₂ ratio	306.0 (254.3-409.8)	333.0 (275.5-411.8)	0.253	322.5 (271.3-406.8)	365.0 (287.0-434.0)	0.276
Hemoglobin (g/dL)	11.3 (2.3)	11.4 (2.4)	0.732	12.9 (2.2)	12.3 (2.4)	0.347
Platelets (10³/μL)	64.0 (41.0-99.5)	77.0 (52.0-119.2)	0.191	110.5 (98.0-157.3)	113.0 (85.0-148.0)	0.337
PT-INR	1.4 (1.2-1.7)	1.3 (1.2-1.5)	0.003	1.2 (1.1-1.2)	1.2 (1.1-1.3)	0.962
aPTT (second)	48.4 (39.4-56.4)	41.0 (37.5-47.3)	0.002	38.6 (34.7-43.9)	38.3 (35.3-42.4)	0.784
Ammonia (μmol/L)	36.0 (25.8-49.5)	34.0 (23.0-49.0)	0.355	31.5 (23.3-36.8)	26.0 (20.0-41.0)	0.661
Bilirubin (mg/dL)	2.4 (1.4-4.3)	1.4 (1.1-2.6)	< 0.001	1.5 (1.0-2.2)	1.2 (0.9-1.5)	0.081
Albumin (g/dL)	3.1 (0.5)	3.2 (0.5)	0.518	3.5 (0.5)	3.3 (0.5)	0.314
Glucose (g/dL)	117.0 (104.0-134.3)	120.0 (105.8-140.8)	0.446	123.5 (105.5-159.3)	120.0 (106.0-141.0)	0.627
Creatinine (mg/dL)	0.8 (0.6-0.9)	0.7 (0.6-0.9)	0.306	0.8 (0.6-0.9)	0.7 (0.6-0.8)	0.497
SBP, baseline (mmHg)	128.0 (115.3-139.0)	128.0 (116.8-147.0)	0.437	131.5 (120.0-144.5)	137.0 (120.0-148.0)	0.330
HR, baseline (beats/minute)	78.0 (68.0-89.3)	80.5 (66.8-91.8)	0.719	72.0 (67.0-85.8)	80.0 (65.0-95.0)	0.388

Data are presented as mean, median, and absolute numbers (%). ASA: American Society of Anesthesiologists; BMI: Body mass index; MELD: Model for end-stage liver disease; METs: Metabolic equivalents; LVEF: Left ventricular ejection fraction; RRT: Renal replacement therapy; PaO₂/FiO₂ ratio: Baseline partial pressure of arterial oxygen to fractional inspired oxygen fraction ratio; PT-INR: Prothrombin time-international normalized ratio; aPTT: Activated partial thromboplastin time; SBP: Systolic blood pressure; HR: Heart rate; N/A: Not applicable.

Table 2 Comparison of intraoperative characteristics between the delayed and early extubation group, n (%)

Variables	Whole group (n = 159)			Subgroup (n = 67)
Variables	Delayed extubation (n = 66)	Early extubation (n = 93)	P value	Delayed extubation (n = 20)	Early extubation (n = 47)	P value
Emergency surgery	4 (6.1)	0 (0.0)	0.028	0 (0.0)	0 (0.0)	N/A
Operation time (hour)	10.8 (9.8-12.7)	9.9 (8.6-12.2)	0.009	11.1 (9.9-13.5)	9.5 (8.1-12.3)	0.025
Anhepatic time (hour)	1.7 (1.3-2.4)	1.4 (1.2-1.8)	0.006	1.7 (1.1-2.5)	1.4 (1.2-1.8)	0.176
Hourly EBL (mL/hour)	212.8 (130.0-415.6)	156.5 (107.1-234.0)	0.004	136.3 (87.7-214.9)	134.5 (102.4-202.3)	0.934
Hourly urine output (mL/hour)	72.9 (51.5-118.9)	92.4 (58.3-134.7)	0.193	97.6 (62.7-162.6)	104.1 (64.5-141.3)	0.924
Hourly administered fluids or blood products
Crystalloid (mL/hour)	170.9 (127.6-240.9)	174.2 (116.8-253.7)	0.776	180.8 (134.5-239.1)	176.8 (133.7-271.0)	0.696
Colloid (mL/hour)	48.0 (34.1-72.9)	40.5 (32.1-58.6)	0.167	34.3 (24.0-55.2)	42.9 (33.1-60.8)	0.198
PRBCs (units/hour)	0.4 (0.0-1.0)	0.2 (0.0-0.5)	0.005	0.0 (0.0-0.4)	0.0 (0.0-0.3)	0.492
FFPs (units/hour)	0.3 (0.0-1.0)	0.2 (0.0-0.4)	0.039	0.0 (0.0-0.2)	0.0 (0.0-0.3)	0.951
Platelets (units/hour)	0.0 (0.0-0.8)	0.0 (0.6)	0.128	0.0 (0.0-0.6)	0.0 (0.0-0.0)	0.399
Total blood products (units/hour)	1.1 (0.0-2.9)	0.8 (0.0-1.5)	0.032	0.0 (0.0-1.1)	0.0 (0.0-0.9)	0.646
Epidural analgesia	1 (1.5)	22 (23.7)	< 0.001	1 (5.0)	22 (46.8)	0.001
Postreperfusion syndrome	58 (87.9)	72 (77.4)	0.140	17 (85.0)	32 (68.1)	0.259
Laboratory findings, ES
PaO₂/FiO₂ ratio	345.5 (303.3-421.3)	374.0 (312.5-436.0)	0.235	343.0 (263.8-435.5)	377.0 (315.0-442.0)	0.351
Lactate (mmol/L)	5.3 (4.1-8.2)	5.6 (3.9-7.0)	0.577	5.2 (4.4-8.2)	5.8 (4.3-7.4)	0.973
Glucose (g/dL)	198.5 (174.8-223.0)	201.0 (170.0-226.5)	0.575	193.0 (171.5-206.0)	194.0 (170.0-216.0)	0.574
SBP, ES (mmHg)	105.0 (95.0-116.3)	130.0 (120.0-145.0)	< 0.001	112.5 (100.0-130.0)	130.0 (120.0-145.0)	0.002
HR, ES (beats/minute)	85.0 (75.0-96.3)	95.0 (85.0-107.5)	< 0.001	87.5 (76.3-105.0)	95.0 (85.0-105.0)	0.153
CVP, ES (mmHg)	6.0 (4.0-7.3)	5.0 (2.5-7.0)	0.030	5.5 (3.0-7.0)	5.0 (3.0-7.0)	0.709
High-dose vasoactive drug, ES	51 (77.3)	36 (38.7)	< 0.001	12 (60.0)	15 (31.9)	0.061

Data were presented as mean, median, and absolute numbers (%). High-dose vasoactive drug defined as dosage ≥ 0.1 µg/kg/minute of norepinephrine equivalent. EBL: Estimated blood loss; PRBCs: Packed red blood cells; FFPs: Fresh frozen plasmas; ES: End of the surgery; PaO₂/FiO2 ratio: Baseline partial pressure of arterial oxygen to fractional inspired oxygen fraction ratio; SBP: Systolic blood pressure; HR: Heart rate; CVP: Central venous pressure; N/A: Not applicable.

Table 3 Multivariate analysis of variables associated with early extubation

Variable	Whole group (n = 159)		Subgroup (n = 67)
Variable	Adjusted OR (95%CI)	P value	Adjusted OR (95%CI)	P value
Anhepatic time (hour)	0.439 (0.232-0.831)	0.011	0.344 (0.116-1.018)	0.054
Epidural analgesia (Reference. No)	15.730 (1.919-128.919)	0.010	19.381 (2.153-174.433)	0.008
High-dose vasoactive drug, ES (Reference. No)	0.235 (0.106-0.519)	< 0.001	0.355 (0.091-1.391)	0.137
MELD score	1.000 (0.938-1.066)	0.994	1.080 (0.926-1.259)	0.325
Postreperfusion syndrome (Reference. No)	1.172 (0.402-3.420)	0.771	0.978 (0.171-5.593)	0.980
Total blood products (units/hour)	0.874 (0.592-1.291)	0.499	0.858 (0.410-1.797)	0.685

High-dose vasoactive drug defined as dosage ≥ 0.1 µg/kg/minute of norepinephrine equivalent. OR: Oodd ratio; CI: Confidence interval; ES: End of the surgery; MELD: Model for end-stage liver disease.

Citation: Jeon S, Lim DG, Kim H, You SB, Kim HJ, Yoon JP, Yang K, Park SJ, Ri HS. Relevant clinical factors for early extubation in living-donor liver transplantation: A single-center retrospective cohort study. World J Clin Cases 2025; 13(14): 102693
URL: https://www.wjgnet.com/2307-8960/full/v13/i14/102693.htm
DOI: https://dx.doi.org/10.12998/wjcc.v13.i14.102693