Readmission to the intensive care unit after liver transplantation

Objective: We undertook this study to understand the factors at our transpl ant center that contribute to patients' return to the ICU after their liver transplant and their initial discharge from that unit. Patients who, after liver transplantation, fail discharge from the Intensive Care Unit (ICU) a nd must be readmitted to that unit may well utilize many more resources tha n those patients who are well enough to stay out of the ICU. Design: A retrospective review of a prospectively maintained liver transpla nt research database followed by a retrospective review of (a subgroup) pat ient charts and contemporaneous controls. Setting: A large metropolitan tertiary care center and adult liver transpla nt center. Patients: A total of 1,197 consecutive adult patients who underwent their i nitial liver transplantation from 1984 to 1996. Intervention: Readmission to the intensive care unit after adult liver tran splantation and discharge from that unit. Main Results: Only recipient age, pretransplant synthetic function labs (pr otime and albumin), bilirubin levels, and intraoperative blood product requ irements could be statistically linked to the group requiring ICU readmissi on. The primary etiology for ICU readmission was cardiopulmonary deteriorat ion. Readmission was associated with significantly lower patient and graft survivals. A detailed review of 23 patients transplanted from October 1994 to June 1996 was made, with special emphasis on cardiopulmonary status (hem odynamics, respiratory variables, and chest radiograph findings). This subg roup was compared with 30 temporally matched controls who were not readmitt ed to the ICU, Intravascular fluid overload and lower inspiratory capacity were significant factors related to ICU readmission. Readmitted patients ha d a longer hospitalization with higher hospital charges than the control gr oup. Conclusions: We conclude that the most important means of preventing ICU re admission in liver transplantation patients is to optimize cardiopulmonary function and status. close monitoring of fluid balance to avoid hypervolemi a is essential. Readmitted patients have a greater resource utilization and have lower survival rates.