Early predictors of prolonged intensive care utilization following liver transplantation

Hunter B Moore; Wells LaRiviere; Ivan Rodriguez; Kristen Brown; Kyndall Hadley; James J Pomposelli; Megan A Adams; Michael E Wachs; Kendra D Conzen; Peter T Kennealey; Bruce Kaplan; Elizabeth A Pomfret; Trevor L Nydam

doi:10.1016/j.amjsurg.2023.06.032

Early predictors of prolonged intensive care utilization following liver transplantation

Am J Surg. 2023 Dec;226(6):829-834. doi: 10.1016/j.amjsurg.2023.06.032. Epub 2023 Jul 13.

Affiliations

¹ Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Colorado Center for Transplantation Care, Research, and Education, Aurora, CO, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA. Electronic address: [email protected].
² Department of Surgery, Division of Transplant Surgery, University of Colorado, USA.
³ Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA.
⁴ Department of Surgery, Division of Transplant Surgery, University of Colorado, USA; Colorado Center for Transplantation Care, Research, and Education, Aurora, CO, USA; Department of Surgery, Division of Transplant Surgery, Children's Hospital Colorado, USA.

PMID: 37604748
DOI: 10.1016/j.amjsurg.2023.06.032

Abstract

Introduction: Creatinine, bilirubin, and fibrinolysis resistance are associated with multi-organ dysfunction and likely risk factors for prolonged intensive care unit (pICU) stay following liver transplantation (LT). We hypothesize postoperative day-1 (POD-1) labs will predict pICU.

Methods: LT recipients had clinical laboratories and viscoelastic testing with tissue plasminogen activator thrombelastography (tPA TEG) to quantify fibrinolysis resistance (LY30) on POD-1. pICU was defined as one week or longer in the ICU. Logistic regression was used to identify the relationship between POD-1 labs and pICU.

Results: Of 304 patients, 50% went to the ICU, with 15% experiencing pICU. Elevated creatinine (OR 6.6, P < 0.001) and low tPA TEG LY30 (OR 3.7, P = 0.004) were independent predictors of pICU after controlling for other risk factors. A 9-fold increase in the rate of 90-day graft loss (19% vs 2% p < 0.001) was observed patients who had these risk factors for pICU.

Conclusion: Elevated creatine and fibrinolysis resistance are associated with pICU and poor outcomes following LT.

Keywords: Critical care; Fibrinolysis; Graft failure; Liver transplant; Renal failure.

MeSH terms

Creatinine
Critical Care
Fibrinolysis
Humans
Liver Transplantation*
Tissue Plasminogen Activator*

Substances

Tissue Plasminogen Activator
Creatinine