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Fast-Track Liver Transplantation: Six-year Prospective Cohort Study with an Enhanced Recovery After Surgery (ERAS)
Gonzalo P Rodríguez-Laiz1,2, Paola Melgar-Requena3,4, Cándido F Alcázar-López3,4
1Hepatobiliary Surgery and Liver Transplantation, Hospital General Universitario de Alicante, Alicante, Spain. gprlaiz@me.com.
World Journal of Surgery
|February 23, 2021
Summary
Implementing a fast-track pathway for liver transplant patients significantly reduces hospital stays and readmissions. This enhanced recovery after surgery (ERAS) protocol demonstrates feasibility as a standard of care, improving patient outcomes.
Area of Science:
- Hepatology
- Transplant Surgery
- Anesthesiology
Background:
- Enhanced recovery after surgery (ERAS) protocols aim to improve patient outcomes and reduce healthcare costs.
- Applying ERAS principles to liver transplantation can optimize the patient journey from operating room to discharge.
Purpose of the Study:
- To evaluate the feasibility and outcomes of a comprehensive "OR-to-discharge" fast-track pathway for liver transplant recipients.
- To assess the impact of this protocol on length of stay, readmission rates, and patient survival.
Main Methods:
- Prospective cohort study of all liver transplants over six years.
- Utilized balanced general anesthesia, fluid restriction, thromboelastometry, and specific surgical techniques.
- Implemented early oral intake and ambulation, with tailored immunosuppression and tacrolimus dosing.
Main Results:
- 240 transplants in 236 patients; mean age 56.3 years.
- Median ICU stay 12.7 hours; median hospital stay 4 days.
- 30-day readmission rate was lower in the fast-track group (28.6% vs. 44.7%).
- One-year patient survival was 86.8%; five-year survival was 78.6%.
Conclusions:
- A comprehensive fast-track pathway for liver transplantation is feasible.
- This protocol can be effectively implemented as the standard of care for liver transplant patients.
- Fast-tracking contributes to reduced hospital stays and improved patient outcomes.
