Predictors of Early Extubation After Pediatric Liver Transplantation: A Single-Center Retrospective Cohort Study

Background Liver transplantation is a cornerstone therapy for pediatric end-stage liver disease. While Enhanced Recovery After Surgery (ERAS) protocols, including early extubation, are well-established in adult liver transplantation, their application in children is more cautious due to unique challenges like malnutrition and poor postoperative cooperation. This study aimed to identify predictors of successful early extubation (within 3 hours postoperatively) in pediatric liver transplant recipients. Methods This was a single-center retrospective cohort study. We analyzed data from 256 patients under 18 years who underwent liver transplantation between September 2019 and November 2022. Patients were divided into Early Extubation (EE, ≤ 3 hours) and Non-Early Extubation (Non-EE, > 3 hours) groups. Univariate and multivariate logistic regression analyses were performed to identify factors associated with EE. Results Of the 256 patients, 155 (61%) were successfully extubated early. Multivariate analysis identified the following independent predictors: favorable factors were higher preoperative albumin (ALB) level (adjusted OR 1.167, p = 0.008) and greater intraoperative urine output (adjusted OR 4.686, p < 0.001); unfavorable factors were higher preoperative white blood cell (WBC) count (adjusted OR 0.806, p = 0.038), higher end-of-surgery serum lactate level (adjusted OR 0.548, p < 0.001), presence of a concurrent respiratory tract infection (adjusted OR 0.307, p = 0.021), and receiving a donation after circulatory death (DCD) graft (adjusted OR 0.260, p = 0.030). The EE group had a significantly shorter median ICU stay (3 vs. 3.5 days, p = 0.002), with no significant difference in 30-day complication rates or total hospital stay. Conclusions Preoperative nutritional and infection status (reflected by ALB, WBC, and respiratory infection), intraoperative organ perfusion and metabolic status (reflected by urine output and lactate level), and graft quality (DCD grafts) are key independent predictors of early extubation after pediatric liver transplantation. Optimizing these factors may facilitate early extubation, potentially shortening ICU stay and supporting the implementation of ERAS protocols in this population.