Management and Outcomes of Patients Requiring Tracheostomy Post Liver Transplant

Document Type

Conference Proceeding

Publication Date

6-1-2023

Publication Title

Am J Transplant

Abstract

Purpose: We evaluated the outcomes of post-liver transplant patients with extended respiratory failure requiring tracheostomy and compared these outcomes to that of patients not requiring tracheostomy. Methods: We compared outcomes of post liver transplant patients at a single institution including those that required tracheostomy following transplantation and those who did not. We reviewed the transplant database of 2158 liver transplant recipients and identified 10 cases that underwent liver transplantation and subsequently required tracheostomy between 2013 and 2020. We compared those cases to 20 controls with no tracheostomy with Kaplan Meier survival curve to compare survival rates. Logistic regression was used to assess associations where the dependent variables are dichotomous. Results: The cases and controls were comparable in terms of age and MELD at transplant with mean age of 56.3 and 56.5 years respectively (p 0.115) and MELD scores of 24 and 25 (p 0.209). All of the cases were Caucasians with 5 males and 5 females. Alcoholic cirrhosis was the most common cause of liver disease in both the cases and controls, underlying 40% and 35% of the liver injuries. Among those who required tracheostomy, 80% were successfully extubated on post-tranplantation day 1; however, eventually developed respiratory failure requiring long-term intubation and ultimately tracheostomy within a median of 118 days post transplantation. In 40% of those requiring tracheostomy pneumonia was the underlying cause of lung injury. Survival at one year in those requiring tracheostomy was only 40% versus 95% of controls (chi-square 11.815, p <0.001). There was no statistically significant difference in rejection rates between the two groups, at 40% and 45% for the cases and controls respectively (p 0.55). Liver transplant recipients with subsequent tracheostomy had significantly longer initial hospital stay following transplantation, with an a mean 32.9 days of hospitalization post-transplant, compared to mean of 11.9 days in the controls with a mean difference of 21 days (95% C.I. 6.2 - 35.7, p <0.001). Conclusions: Liver transplant patients who required tracheostomy had longer initial hospitalization following transplantation and significantly lower survival rates in the first 12 months following transplantation. Rejection rates were not found to different among the two groups. Figure 1. Kaplan-Meier survival cure for liver transplant patient patients who underwent tracheostomy (blue) and those who did not undergo tracheostomy following transplant in the first 12 months following transplant. CITATION INFORMATION: Taye K., Suresh S., Jafri S. Management and Outcomes of Patients Requiring Tracheostomy Post Liver Transplant AJT, Volume 23, Issue 6, Supplement 1. DISCLOSURES: K.Taye: None. S.Suresh: n/a. S.Jafri: Speakers Bureau;; Gilead, Takeda, Abbvie. [Figure presented]

PubMed ID

Not assigned.

Volume

23

Issue

Suppl 1

First Page

S1182

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