One-year functional and neuropsychological outcomes of liver transplant recipients undergoing prolonged mechanical ventilation

Background: Liver transplantation (LT) is increasingly performed on patients with comorbidities, including critically ill individuals requiring extended intensive care unit (ICU) care. Little is known about these recipients' long-term functional and neuropsychological outcomes. This study aimed to assess the impact of prolonged ICU stays and mechanical ventilation on LT recipients. Methods: We examined 1-year outcomes of LT recipients with prolonged mechanical ventilation (MV) exceeding 7 days in the multicentre RECOVER program (2009-2014). Assessments occurred at 7 days and 3, 6, and 12 months post-ICU discharge, focusing on the functional independence measure (FIM), Medical Research Council (MRC), 6-minute walk test (6MWT), and short-form-36 (SF-36) survey. Psychological assessment used the impact of event scale (IES) and Beck depression inventory-II (BDI-II). Caregivers' psychological outcomes were also evaluated. Results: Fourteen LT recipients (42.9% male; mean age 50 years) with median MV of 16.5 (14.0-25.8) days were included; 13 survived to ICU discharge (median ICU stay 19.5 [15.5-31.2] days). FIM scores showed persistent cognitive and motor function limitations, plateauing at 3 months. At 12 months, total FIM was 87.7 (SD 48.1), indicating moderate assistance need. The 6MWT was 71.6% predicted; SF-36 physical component score was 44.6 SD 9.1. Average BDI-II of 9.9 (SD 13.8) at 1 year indicated minimal depressive symptoms; mean IES score (24.4 SD 28.8) suggested post-traumatic stress disorder symptoms. Caregivers also experienced persistent depressive symptoms. Conclusions: LT recipients with prolonged MV exhibited lasting functional and cognitive limitations at 1-year follow-up, underscoring the potential benefits of targeted rehabilitation interventions for enhanced recovery.