Anne De Voll-Zabrocki, Wendy Grant, Jean Botha, David Mercer, Alan Langnas

Transplant Surgery, University Nebraska Medical Center, Omaha, NE, United States

Intensive care management of pediatric intestinal transplant (IT) recipients in the immediate post-operative period is challenging. Our aim was to identify risk factors for prolonged ventilator needs and the impact of inability to rapidly wean patients on their early clinical course. A cutoff for extubation within 48 hours of IT operation was our definition of inability to rapidly wean patients.

Methods: A retrospective chart review of the first 6 weeks following primary IT in recipients age < 5 years during a 3 year period was performed. Demographics, operative parameters, ventilator days and complications were examined.

Results: Of the 85 IT performed during the 3 year period, 36 met inclusion criteria. Of these, 17 patients were not successfully extubated within 48 hours of the IT operation (NE) and 19 were (E). The median age and weight in the NE group were significantly lower than the E group, 0.91yrs vs. 1.58yrs (p=.0009) and 7.47kg vs. 9.70kg (p=0.014) respectively. Operative time, transfusion volume per kilogram during IT operation, gestational age, number of reoperations and donor/recipient weight ratio were similar between the groups. When compared to the E group, gastroschisis as cause of intestinal failure, history of pre-transplant ventilator needs and need for a graft that included a liver were more common in the NE group.

The consequences of not being extubated within 48 hours were increased number of chest radiographs (median 33 for NE and 8 for E, p=0001), blood gas draws (median 109 for NE and 8.5 for E, p<0.0001) and length of stay in the intensive care unit (median 40 days for NE and 13 days for E, p=0.0003).

Discussion: Smaller and younger IT recipients were less likely to be extubated within 48 hours of IT operation. Intraoperative parameters do not appear to have an impact on ability to extubate.