Immediate Extubation Following Living Donor Liver Transplantation: Feasibility, Safety, and Impact on Early Outcomes.

Abstract

Background: Early extubation is a key component of enhanced recovery pathways but remains underutilized in living donor liver transplantation. This single-center retrospective cohort study evaluates the feasibility, safety, and clinical outcomes of immediate operating room extubation using standardized intraoperative physiological criteria.

Methods: A total of 158 consecutive adult LDLT recipients meeting standardized intraoperative extubation criteria were included and categorized into immediate (OR) and delayed (ICU) extubation groups. Primary outcomes were reintubation rate and ICU and hospital length of stay, whereas secondary outcome was 1-year overall survival stratified by MELD score.

Results: Among 158 patients, 47 (29.7%) underwent immediate extubation, with reintubation in one case (2.1%). Immediate extubation was associated with a shorter median ICU stay (4 [IQR 4-5] vs. 5 [IQR 4-5] days, p < 0.001) and a nonsignificant reduction in hospital stay (11 [IQR 10-13] vs. 12 [IQR 11-14] days, p = 0.084). One-year OS was higher in the immediate group (95% vs. 80%, p = 0.013), with improved survival in MELD 21-30 patients (100% vs. 70%, p = 0.047).

Conclusion: Immediate extubation after LDLT appears feasible and safe in carefully selected patients. The observed shorter ICU stay and favorable survival among patients with moderate MELD scores require validation in appropriately matched comparative cohorts.