Adopting Early Extubation in Pediatric Living Donor Liver Transplantation: A Focus on Feasibility and Safety of the Practice

Abstract

Background

Pediatric living donor liver transplant (LDLT) presents with its own unique challenges and requires considerable surgical and anesthetic expertise for a favorable outcome. One of the critical determinants of improved outcomes following liver transplantation is early extubation (EE). We conducted this study to determine our rate of EE and evaluate the predictive factors for successful EE in pediatric patients undergoing LDLT.

Methods

We performed a retrospective observational study and analyzed our data on pediatric patients (Aged 3 months to 10 years) who underwent LDLT from January 2022 to June 2024. Our primary objective was to evaluate the rate of EE after liver transplant in the pediatric population and demonstrate its safety across all ages. The secondary outcome was to determine predictive factors for successful EE in this population.

Results

A total of 28 patients were enrolled in the study and were divided into 2 groups: Early extubation (EE group (extubated on-table or ≤4 h postoperatively) and delayed extubation (DE) group (mechanically ventilated >4 h postoperatively). Out of 28 patients, 23 patients (82.1%) were successfully extubated on-table whereas 5 patients (17.9%) were included in the DE group. In our study, both the groups were comparable in demographic, preoperative, and intraoperative parameters except for age of children and duration of surgery, which were statistically significant between the groups.

Conclusion

Early extubation in pediatric patients is not only feasible but also a safe practice. Although, the retrospective nature of the study, small cohort, and exclusion of high-risk groups such as acute liver failure limit statistical power, the results are encouraging. Generalizability and validation of our clinical protocols warrant prospective studies with larger cohorts.