Emergency department evaluation of orthotopic liver transplant recipients

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Introduction

The intensive care unit (ICU) has an important role in the early management of orthotopic liver transplantation (OLT) recipients.

Patients and methods

We reviewed the records of the 83 consecutive patients (91 procedures) who underwent OLT from September 1992 to June 1999 in our centre, collecting sample characteristics, reviewing the early complications after OLT and the changes in medical care of these patients over the past seven years.

Results

Most frequent indications for primary OLT and for retransplantation were familial amyloidotic polyneuropathy (37.3%) and hepatic artery thrombosis (75%), respectively. The most challenging complications seen were acute renal failure (31.3%), postoperative bleeding (15.6%), infections (9.6%), acute cellular rejection (9.6%) and warm ischemia (8.4%), with lethal primary nonfunction ensuing it in three cases, the most common cause of death in ICU. There was considerable reduction in operative time (7.1 ± 1.36 vs 5.8 ± 0.83 h; P<0.001), blood transfusions requirement (8.1 ± 4.6 vs 4.9 ± 2.7 units; P<0.01), ventilation time in the routine patient (51 ± 30 vs 30 ± 30 h; P<0.05) and in ICU length of stay (6.2 ± 2.7 vs 3.9 ± 2.5 days; P<0.002) between the two time periods in which we equally divided our sample (92–96 and 97–99) with a sensible reduction in ICU morbidity (48% vs 24% of moderate-to-severe complications; P<0.02).

Discussion and conclusions

The reduction in procedure and ICU invasiveness throughout the years allowed for a reduction in morbidity and may confirm that appropriate medical care can overcome the adverse influences of many of the negative predictor factors suggested to influence OLT recipients outcome.