{
  "abstract": "Introduction Expected Intensive Care Unit (ICU) stay following Liver Transplant (LT) is 2–3 days. 1 However, this complex procedure may result in extended ICU stay due to secondary organ dysfunction and post-operative complications.2 Prolonged ICU admission is associated with worse patient outcomes, including mortality.3 Little UK data exists for exploring hospital outcomes of LT recipients with prolonged ICU admission.4 Aim To review patient and hospital characteristics of LT recipients, requiring prolonged ICU admission, at a specialist UK transplant centre.Methods Data for consecutive adult LT recipients admitted to a large, specialist UK transplant centre was collected retrospectively between March 2023 – April 2025. Patients requiring ≥4 ICU days following LT were included. Patient demographics and hospital outcomes were collected via routine electronic records. Reason for prolonged admission was defined by clinical noting at ICU discharge and stratified into groups. Physical function at ICU and hospital discharge was assessed using the Manchester Mobility Scale (MMS).Results 394 patients received a LT between the study period, with 146 (37.1%) requiring ≥4 days ICU stay. Patient demographics are presented in table 1. ICU length of stay (LOS) was 7 days (IQR; 6–13.5) and total hospital LOS 20 days (IQR;14–34). 136 (93.2%) patients survived hospital admission, with all mortalities occurring in the ICU (n=10, 6.8%). Reasons for prolonged ICU admission included renal replacement therapy (n=53), vasopressor support (n=41), respiratory failure (n=39), return to theatre (n=22) and multi-organ failure (n=21), with patients often having multiple reasons for prolonged admission. Hospital outcomes can be found in table 1.It took 4.5 days (IQR; 3–7) on the ICU to mobilise, with 93 (70%) patients able to step transfer or better (MMS ≥5) at ICU discharge. At hospital discharge, 122 (91.7%) patients could mobilise >30m, although only 58.6% achieved >100m. Of hospital survivors, 127 (87%) patients were discharged home, with 26 (17.8%) patients having ongoing rehabilitation requirements.Abstract P132 Table 1Patient characteristics and hospital outcomes Characteristics N Statistic Age (Years) 146 56 (IQR; 45–62) Male Sex 146 89 (60.1%) BMI (kg/m2) 146 29 (IQR; 25.4 – 31.1) APACHE II 146 18.8 +/- 5.3 UKELD 124 55.1 +/- 5.5 Indication for transplant 146 Auto immune hepatitis Hepatitis (A, B, C, E) Genetic/metabolic disorder MASLD/NASH/NAFLD Alcohol related disease Biliary disorders Hepatocellular Carcinoma Acute live failure Other 6 (4.1%)6 (4.1%)4 (2.7%)24 (16.4%)42 (28.8%)23 (15.8%)13 (8.9%)15 (10.3%)13 (8.9%) Graft type 146 Donation after brainstem death Donation after cardiac death 96 (65.8.%)50 (34.2%) Hospital outcomes Mortality 146 OverallICUWard 10 (6.8%)10 (6.8%)0 (0%) Duration of mechanical ventilation (days) 146 2 (IQR; 2–7) <4 days4–7 days>7 days 87 (59.6%)28 (19.2%)31 (21.2%) Sedation days 146 2 (IQR; 2–6) Time to mobilise (days) 140 4.5 (IQR; 3–7) Tracheostomy 146 15 (8.9%) Delirium 142 75 (52.8%) ICU LOS (days) 136 7 (6 – 13.5) ICU discharge MMS 136 1234567 7 (5.2%)10 (7.5)4 (3%)19 (14.3%)45 (33.8%)15 (11.4%)33 (24.8%) Reason for prolonged ICU admission 136 Return to theatre Vasopressors Renal placement therapy Respiratory failure Neurological disorder Coagulopathy Lack of bed capacity Severe graft dysfunction Multi organ failure 22415339817111021 Re-admitted to ICU 136 13 (9.6%) Hospital LOS (days) 133 20 (IQR; 13–34) Hospital discharge MMS 133 367 1 (0.8%)10 (7.5%)122 (91.7%) Discharge destination 146 HomeHome with rehabilitationInpatient rehabilitationDiedHospital transferRemains inpatient 106 (72.6%)21 (14.4%)5 (3.4%)10 (6.8%)1 (0.7%)3 (2.1%) Discussion Patients requiring prolonged ICU admission following LT experienced good hospital and physical outcomes, despite post-procedural complications. Increased ward-based LOS was evident, with many patients unable to mobilise >100m at discharge and requiring ongoing rehabilitation. Delayed time to mobilise and reduced ICU mobility may be because of limited rehabilitation input (due to sparse resources or clinical prioritisation), or medical instability. Enhanced, targeted rehabilitation may lead to improved hospital outcomes. However, work should be done to identify opportunities to improve care and identify those patients most likely to benefit.References Kumar SI, Kim S, Winnie K, Cobb JP, Brown J. Pilot implementation of a novel ICU admission, discharge, and triage tool at an academic medical center. Am J Respir Crit Care Med. 2017;195.Pedersen MR, Choi M, Brink JA, Seetharam AB. ‘Pretransplant factors and associations with postoperative respiratory failure, ICU length of stay, and short-term survival after liver transplantation in a high MELD population. Journal of Transplantation 2016;(1):6787854.Hill AD, Fowler RA, Pinto R, Herridge MS, Cuthbertson BH, Scales DC. Long-term outcomes and healthcare utilization following critical illness--a population-based study. Crit Care 2016;20:76.Tanaka T, Reichman TW, Olmos A, Akamatsu N, Mrzljak A, Spiro M, Raptis DA, Berlakovich G, ERAS4OLT.org Working Group. When is the optimal time to discharge patients after liver transplantation with respect to short-term outcomes? A systematic review of the literature and expert panel recommendations. Clin Transplant 2002;36(10).",
  "authors": [
    {
      "affiliations": [
        "Queen Elizabeth Hospital Birmingham, UK"
      ],
      "name": "Adam Harriman"
    },
    {
      "affiliations": [
        "Queen Elizabeth Hospital Birmingham, UK"
      ],
      "name": "Ashlea Hargreaves"
    }
  ],
  "title": "P132 Outcomes of liver transplant patients requiring prolonged intensive care admission at a high-volume, specialist transplant centre – a service evaluation",
  "uid": "6c007077-6597-542c-8dc9-02f722038029"
}