• Yuichi Chihara, Hiroto Egawa, Toru Oga, Tomomasa Tsuboi, Tomohiro Handa, Shintaro Yagi, Taku Iida, Atsushi Yoshizawa, Kazuhiko Yamamoto, Michiaki Mishima, Koichi Tanaka, Shinji Uemoto, and Kazuo Chin.
• Department of Respiratory Medicine, Kyoto University Hospital, Kyoto, Japan.
• Plos One. 2013 Jan 1;8(12):e81417.

BackgroundPostoperative respiratory complications are a major cause of mortality following liver transplantation (LT). Noninvasive ventilation (NIV) appears to be effective for respiratory complications in patients undergoing solid organ transplantation; however, mortality has been high in patients who experienced reintubation in spite of NIV therapy. The predictors of reintubation following NIV therapy after LT are not exactly known.MethodsOf 511 adult patients who received living-donor LT, data on the 179 who were treated by NIV were retrospectively examined.ResultsForty-three (24%) of the 179 patients who received NIV treatment required reintubation. Independent factors associated with reintubation by multivariate logistic regression analysis were controlled preoperative infections (odds ratio [OR] 8.88; 95% confidence interval (CI) 1.64 to 48.11; p = 0.01), ABO-incompatibility (OR 4.49; 95% CI, 1.50 to 13.38; p = 0.007), and presence of postoperative pneumonia at the time of starting NIV (OR 3.28; 95% CI, 1.02 to 11.01; p = 0.04). The reintubated patients had a significant higher rate of postoperative infectious complications and a significantly longer intensive care unit stay than those in whom NIV was successful (p<0.0001). Of the 43 reintubated patients, 22 (51.2%) died during hospitalization following LT vs. 8 (5.9%) of the 136 patients in whom NIV was successful (p<0.0001).ConclusionsBecause controlled preoperative infection, ABO-incompatibility or pneumonia prior to the start of NIV were independent risk factors for reintubation following NIV, caution should be used in applying NIV in patients with these conditions considering the high rate of mortality in patients requiring reintubation following NIV.

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