Fast tracking in liver transplantation: which patient benefits from this approach?

In liver transplantation, "fast tracking" means postoperative extubation in the operating theater immediately after surgery. This procedure was performed in a series of 837 adult liver transplant recipients between January 1997 and April 2005, proving to be safe and feasible in almost 80% of patients without increasing the incidence of reintubation. This patient population experienced a significantly higher survival compared to patients who were extubated in the intensive care unit. Consequently, fast tracking should become the standard procedure after orthotopic liver transplantation. However, special attention is required for recipients with acute liver failure, retransplantation, Child C status, or complicated surgery in terms of increased transfusion of red blood cells. These patients do not participate in fast-tracking protocols, as demonstrated by a uni- and multivariate logistic regression analysis. Moreover, ROC analysis revealed that only intraoperative transfusion of </=6 units of red blood cells was associated with extubation in the operating theater with highest sensitivity (78.9%) and specificity (49.5%), area under the ROC curve = 0.703 (standard error = 0.023; 95% confidence interval = 0.671-0.734).