Graham, Ryan C.Bush, Weston J.Mella, Jeffrey S.Fridell, Jonathan A.Ekser, BurcinMihaylov, PlamenKubal, Chandrashekhar A.Mangus, Richard S.2021-04-232021-04-232020-08-11Graham, R. C., Bush, W. J., Mella, J. S., Fridell, J. A., Ekser, B., Mihaylov, P., Kubal, C. A., & Mangus, R. S. (2020). Tracheostomy Post Liver Transplant: Predictors, Complications, and Outcomes. Annals of Transplantation, 25. https://doi.org/10.12659/AOT.9206301425-9524, 2329-0358https://hdl.handle.net/1805/25741Background Liver transplant (LT) patients have an increased risk of postoperative respiratory failure requiring tracheostomy. This study sought to characterize objective clinical predictors of tracheostomy. Material/Methods The records for 2017 LT patients at a single institution were reviewed. Patients requiring tracheostomy were first compared with all other patients. A case-control subgroup analysis was conducted in which 98 tracheostomy patients were matched with 98 non-tracheostomy LT patients. For the case-control study, muscle mass was assessed using preoperative computed tomography scans. Results Among 2017 LT patients, 98 required tracheostomy (5%), with a 19% complication rate. Tracheostomy patients were older and had a higher model for end-stage liver disease score, a lower body mass index (BMI), and a greater smoking history. Tracheostomy patients had a longer hospital stay (45 vs. 10 days, P<0.001) and worse 1-year survival (65% vs. 91%, P<0.001). Ten-year Cox regression patient survival for tracheostomy patients was significantly worse (32% vs. 68%, P<0.001). In the case-control analysis, respiratory failure patients were older (P<0.01) and had a lower BMI (P=0.05). They also had a muscle mass deficit of −39% compared with matched LT controls (P<0.001). No significant differences were seen with pre-LT total protein or albumin or with forced expiratory volume in 1 s divided by forced vital capacity (FEV1/FVC) values. Conclusions Predictors for respiratory failure requiring post-LT tracheostomy include higher model for end-stage liver disease score, older age, lower BMI, greater smoking history, and worse sarcopenia. Patients requiring tracheostomy have dramatically longer hospital stays and worse survival.en-USAttribution-NonCommercial-NoDerivatives 4.0 InternationalFrail ElderlyLiver TransplantationMalnutritionPostoperative ComplicationsRespirationArtificialTracheostomyArticle