Stratigopoulou Panagiota, Paul Andreas, Hoyer Dieter P, Kykalos Stylianos, Saner Fuat H, Sotiropoulos Georgios C
Department of General, Visceral and Transplantation Surgery University Hospital Essen, Essen, Germany.
PLoS One. 2017 Mar 20;12(3):e0174173. doi: 10.1371/journal.pone.0174173. eCollection 2017.
The aim of the present study is to determine the incidence of a prolonged (>3 days) initial ICU-stay after liver transplantation (LT) and to identify risk factors for it.
We retrospectively analyzed data of adult recipients who underwent deceased donor first-LT at the University Hospital Essen between 11/2003 and 07/2012 and showed a primary graft function.
Of the 374 recipients, 225 (60.16%) had prolonged ICU-stay. On univariate analysis, donor INR, high doses of vasopressors, "rescue-offer" grafts, being hospitalized at transplant, high urgency cases, labMELD, alcoholic cirrhosis, being on renal dialysis and length of surgery were associated with prolonged ICU-stay. After multivariate analysis, only the labMELD and the operation's length were independently correlated with prolonged ICU-stay. Cut-off values for these variables were 19 and 293.5 min, respectively. Hospital stay was longer for patients with a prolonged initial ICU-stay (p<0.001). Survival rates differed significantly between the two groups at 3 months, 1-year and 5-years after LT (p<0.001).
LabMELD and duration of LT were identified as independent predictors for prolonged ICU-stay after LT. Identification of recipients in need of longer ICU-stay could contribute to a more evidenced-based and cost-effective use of ICU facilities in transplant centers.
本研究旨在确定肝移植（LT）后初始入住重症监护病房（ICU）时间延长（>3天）的发生率，并确定其危险因素。
我们回顾性分析了2003年11月至2012年7月在埃森大学医院接受脑死亡供体首次肝移植且具有原发性移植物功能的成年受者的数据。
374例受者中, 225例（60.16%）入住ICU时间延长。单因素分析显示，供体国际标准化比值（INR）、高剂量血管升压药、“救援性供肝”、移植时住院、高紧急度病例（high urgency cases）、实验室终末期肝病模型（labMELD）评分、酒精性肝硬化、接受肾透析以及手术时长与入住ICU时间延长有关。多因素分析后，只有labMELD评分和手术时长与入住ICU时间延长独立相关。这些变量的临界值分别为19和293.5分钟。初始入住ICU时间延长的患者住院时间更长（p<0.001）。肝移植后3个月、1年和5年时，两组患者的生存率差异有统计学意义（p<0.001）。
LabMELD评分和肝移植手术时长被确定为肝移植后入住ICU时间延长的独立预测因素。识别需要更长时间入住ICU的受者有助于移植中心更循证且经济高效地使用ICU设施。
