Decreased Ventilation Duration and ICU Stay Associated With Early Percutaneous Dilatational Tracheostomy After Liver Transplantation

BACKGROUND Liver transplantation in critically ill patients with advanced cirrhosis frequently leads to prolonged ventilation. Percutaneous dilatational tracheostomy is widely used to facilitate weaning, yet the optimal timing after liver transplantation remains uncertain. MATERIAL AND METHODS This retrospective single-center study analyzed 83 of 1352 liver transplant recipients (6.1%) who underwent percutaneous dilatational tracheostomy between December 2010 and June 2024. Patients were retrospectively categorized as early (≤7 days) or late (≥8 days) according to the interval from liver transplantation to tracheostomy. Clinical and laboratory parameters were assessed using group comparisons, multivariable linear regression (with and without log-transformed outcomes), Cox regression, and Kaplan-Meier survival analysis. RESULTS Patients who underwent early percutaneous dilatational tracheostomy had lower platelet counts (57 vs 97×109/L; P =0.047) and higher aspartate aminotransferase (72 vs 46 U/L; P =0.022), alanine aminotransferase (249 vs 67 U/L; P <0.001), and creatinine levels (175 vs 141 μmol/L; P =0.033). Early percutaneous dilatational tracheostomy was independently associated with a shorter intensive care unit stay (β=-0.651; 95% CI, -1.087 to -0.214; P =0.004; 47.8% reduction) and shorter mechanical ventilation duration (β=-0.560; 95% CI, -1.027 to -0.093; P =0.020; 42.9% reduction). No significant survival difference was found between early and late percutaneous dilatational tracheostomy (Cox hazard ratio, 0.76; 95% CI, 0.41-1.40; P =0.37). CONCLUSIONS Early percutaneous dilatational tracheostomy was associated with reduced intensive care unit and ventilation times but did not confer a survival benefit. These findings should be interpreted cautiously, given the retrospective single-center design.