Intensive care unit management in liver transplant recipients: beneficial effect on survival and preservation of quality of life.

Determinants of outcome of intensive care unit (ICU) stay and quality of life in survivors was prospectively assessed in 50 consecutive liver transplant recipients requiring intensive care unit (ICU) management. Variables assessed included demographic, clinical and laboratory characteristics, measures of severity of illness (Child-Pugh, Apache II, and organ system failure scores) and quality of life measures (physical functioning, perceived quality of life, stress, depression, and adaptive coping). Overall ICU survival was 82% (41/50). Nonsurvivors had significantly higher acute physiology scores (p = 0.03). Apache II score (p = 0.03), Karnofsky score (p = 0.01) and serum bilirubin (p = 0.05) on admission than survivors. Nonalert mental status (p = 0.0002), hypothermia (p = 0.035) and hypotension (p = 0.027) on admission were significantly associated with mortality. During the ICU stay, requirement of mechanical ventilation (p = 0.02), duration of ventilation (p = 0.01), requirement of dialysis (p = 0.0005), development of pulmonary infiltrates (p = 0.0001) and infections in the ICU (p = 0.003) were significantly associated with mortality. Requirement of mechanical ventilation was an independently significant predictor of mortality (with mechanical ventilation, dialysis and infections in the logistic regression analysis model). There was no difference in post-discharge quality of life (as assessed by the perceived quality of life, stress, depression, and coping scores) in survivors of ICU stay as compared with patients who never required ICU care. Our study suggests that the ICU management can have a positive impact on outcome for liver transplant recipients. If they survive (and 82% did in this study), their quality of life is unaffected and as good as those whose postoperative course was not complicated by a critical illness requiring ICU care.