Muhammad Nauman-Ul-Haq, Muhammad Zakariya Amjad, Saad Ahmed Naveed, Haseeb Haider Zia, Nusrat Yar Khan, Maliha Aziz, Abid Ilyas, Ayesha Junaid, Nasir Ayub Khan, Abu Bakar Hafeez Bhatti
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Primary outcomes were reintubation rate and ICU and hospital length of stay, whereas secondary outcome was 1-year overall survival stratified by MELD score.</p><p><strong>Results: </strong>Among 158 patients, 47 (29.7%) underwent immediate extubation, with reintubation in one case (2.1%). Immediate extubation was associated with a shorter median ICU stay (4 [IQR 4-5] vs. 5 [IQR 4-5] days, <i>p</i> < 0.001) and a nonsignificant reduction in hospital stay (11 [IQR 10-13] vs. 12 [IQR 11-14] days, <i>p</i> = 0.084). One-year OS was higher in the immediate group (95% vs. 80%, <i>p</i> = 0.013), with improved survival in MELD 21-30 patients (100% vs. 70%, <i>p</i> = 0.047).</p><p><strong>Conclusion: </strong>Immediate extubation after LDLT appears feasible and safe in carefully selected patients. 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引用次数: 0
摘要
背景：早期拔管是增强恢复途径的关键组成部分，但在活体肝移植中仍未得到充分利用。本单中心回顾性队列研究采用标准化的术中生理标准评估立即在手术室拔管的可行性、安全性和临床结果。方法：共纳入158例符合标准化术中拔管标准的连续成人LDLT受者，并将其分为立即（OR）和延迟（ICU）拔管组。主要结局是再插管率、ICU和住院时间，而次要结局是按MELD评分分层的1年总生存期。结果：158例患者中，47例（29.7%）立即拔管，1例（2.1%）再次拔管。立即拔管与ICU住院时间中位数缩短相关（4 [IQR 4-5]对5 [IQR 4-5]天，p < 0.001），住院时间无显著减少（11 [IQR 10-13]对12 [IQR 11-14]天，p = 0.084）。直接治疗组的1年OS更高（95% vs 80%, p = 0.013）， MELD 21-30患者的生存率更高（100% vs 70%, p = 0.047）。结论：在精心挑选的患者中，LDLT术后立即拔管是可行和安全的。在中度MELD评分的患者中观察到的较短的ICU住院时间和较好的生存率需要在适当匹配的比较队列中进行验证。
Immediate Extubation Following Living Donor Liver Transplantation: Feasibility, Safety, and Impact on Early Outcomes.
Background: Early extubation is a key component of enhanced recovery pathways but remains underutilized in living donor liver transplantation. This single-center retrospective cohort study evaluates the feasibility, safety, and clinical outcomes of immediate operating room extubation using standardized intraoperative physiological criteria.
Methods: A total of 158 consecutive adult LDLT recipients meeting standardized intraoperative extubation criteria were included and categorized into immediate (OR) and delayed (ICU) extubation groups. Primary outcomes were reintubation rate and ICU and hospital length of stay, whereas secondary outcome was 1-year overall survival stratified by MELD score.
Results: Among 158 patients, 47 (29.7%) underwent immediate extubation, with reintubation in one case (2.1%). Immediate extubation was associated with a shorter median ICU stay (4 [IQR 4-5] vs. 5 [IQR 4-5] days, p < 0.001) and a nonsignificant reduction in hospital stay (11 [IQR 10-13] vs. 12 [IQR 11-14] days, p = 0.084). One-year OS was higher in the immediate group (95% vs. 80%, p = 0.013), with improved survival in MELD 21-30 patients (100% vs. 70%, p = 0.047).
Conclusion: Immediate extubation after LDLT appears feasible and safe in carefully selected patients. The observed shorter ICU stay and favorable survival among patients with moderate MELD scores require validation in appropriately matched comparative cohorts.
期刊介绍：
International Journal of Hepatology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies related to the medical, surgical, pathological, biochemical, and physiological aspects of hepatology, as well as the management of disorders affecting the liver, gallbladder, biliary tree, and pancreas.
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