Association Between Fast-Track Extubation After Orthotopic Liver Transplant, Postoperative Vasopressor Requirement, and Acute Kidney Injury

Objectives: Acute kidney injury is a significant cause of morbidity after orthotopic liver transplant. Early extubation after liver transplant may have a beneficial effect on postoperative renal function. This may be the result of reduction in vasopressor-mediated vasoconstriction used to counteract the hypotension associated with sedative use and the effects of positive-pressure ventilation. Previous studies explored advantages of early extubation after liver transplant but focused on resource usage rather than clinical benefit. This study was designed to determine the association between fast-track extubation and reduction in postoperative vasopressor requirement and whether this had any association with acute kidney injury incidence or renal replacement therapy requirement. Materials and Methods: Data were collected from 144 orthotopic liver transplants. A propensity-matched case- control analysis was conducted on a subgroup of 33 patients who were fast-track extubated and with 33 propensity score-matched control patients who were not. The primary outcome was median days of postoperative vasopressor use, and secondary outcomes included incidence of acute kidney injury, renal replacement therapy requirement, and critical care admission duration. Results: The fast-track extubation group had a shorter postoperative vasopressor requirement (0 vs 2 days; P <.01) and a reduced need for renal replacement therapy (3% vs 21.2%; P =.05). Median critical care admission duration (3 vs 4 days; P =.03) and hospital admission duration (14 vs 19 days; P =.04) were shorter in the fast-track extubation group. Conclusions: This is the first study to reveal a significant association between fast-track extubation and reduced postoperative vasopressor requirement. Additionally, this was associated with a trend toward reduced renal replacement requirement after liver transplant. It suggests that early extubation may not just be a resource benefit to an institution but may convey a clinical benefit to patients through a reduction in organ failure and requirement for organ support.