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

BACKGROUND

Clinical guidelines for early extubation after liver transplantation remain lacking, with significant variations in the rates of early extubation across transplantation centers.

AIM

To identify clinical factors, including the use of epidural analgesia, associated with early extubation in living-donor liver transplantation (LDLT).

METHODS

The medical records of LDLT recipients were analyzed in this study, categorizing them based on extubation timing as delayed (leaving the operating room without extubation) or early (tracheal tube removed immediately after surgery). A multivariate binary logistic regression analysis was performed. Subgroup analysis was conducted, excluding patients contraindicated for epidural analgesia owing to significant coagulopathy.

RESULTS

Total of 159 patients, 93 (58.5%) underwent early extubation. Relevant clinical factors of early extubation were shorter anhepatic time [adjusted odds ratio (OR) = 0.439, 95% confidence interval (CI): 0.232-0.831; = 0.011], absence of high-dose vasoactive drug use at the end of surgery (OR = 0.235, 95%CI: 0.106-0.519; < 0.001), and the use of epidural analgesia (OR = 15.730, 95%CI: 1.919-128.919; = 0.010). In a subgroup analysis of 67 patients, epidural analgesia remained a relevant clinical factor for early extubation (adjusted OR = 19.381, 95%CI: 2.15-174.433; = 0.008).

CONCLUSION

Shorter anhepatic time, absence of high-dose vasoactive drug use at the end of surgery, and the use of epidural analgesia are relevant clinical factors of early extubation following LDLT.