Patients with liver transplantation readmitted to the ICU: a 15-year retrospective study

Objective

To evaluate risk factors and outcomes in patients with liver transplantation who were readmitted to our ICU after liver transplantation during their hospital stay.

Design

A 15-year retrospective study.

Patients

A total of 152 (102 male and 50 female) patients admitted to our ICU after liver transplantation over a 15-year period (1990–2004).

Results

Of the 129 patients who survived the first ICU stay after liver transplantation, 28 patients (17 male and 11 female) (21.7%) were readmitted. The mean age was 44 ± 14.3 years, SAPS II score of first ICU admission and readmission were, respectively, 37 ± 7.1 (predicted mortality 39.4%) and 41.3 ± 10.8 (predicted mortality 47.6%). SAPS II score for non-readmitted (NREAD) ICU patients was 32.9 ± 5.8 (predicted mortality 31.7%). The recipient age was similar between readmitted (READ) and NREAD patients. Child-Pugh class C was 71% for NREAD and 82.2% for READ patients. The time between extubation and ICU discharge was 1.4 ± 0.7 days. Early readmission (<48 hours after ICU discharge) occurred in 25% of READ patients. Causes of early readmission were acute respiratory failure (ARF) 42.8%, cardiac disorders 28.5% and gastrointestinal (GI) surgical complications 28.5%. Causes of late readmission (days between first ICU admission and readmission was 17.8 ± 13.8) were ARF 43.3%, cardiac disorders 6.7%, GI surgical complications 36.6%, sepsis 6.7%, CNS complications 6.7%. First ICU stay was 5.1 ± 6.1 days for READ patients and 3.8 ± 3.3 days for NREAD. Readmission ICU stay was 6.25 ± 5.9 days. ICU mortality for READ patients was 42.8%. Three-month mortality was 68% for NREAD patients and 76.8% for READ patients.

Conclusion

The results of this study provide evidence that READ patients appeared to be sicker than NREAD and they had longer length of first ICU stay. Cardiopulmonary complications were the main cause of early or late readmission, and the ICU and 3-month mortality was higher for patients readmitted to the ICU after liver transplantation.