Textbook Outcome Following Liver Transplantation: A Systematic Review

Despite advances in perioperative care and immunosuppressive therapy in liver transplantation (LT), and the broadening of eligibility criteria and indications for LT, the complexity of this procedure makes the configuration of a textbook outcome (TO) rather difficult to define an optimal postoperative follow up. In this article, we evaluate and summarize the data in the literature concerning textbook outcome in liver transplantation (TOLT).

Four studies discussing TOLT were included and evaluated in our literature review. Three studies had, as inclusion criteria, adult patients who had undergone elective primary LT, without association with another organ transplant, with a deceased donor. The fourth study included patients who had undergone an enhanced recovery after surgery (ERAS) protocol prior to their LT during the study period, with no other selection criteria.

The frequency of TOLT in the four studies described ranged from 31 to 37.5%. The definition of TOLT was variable between the different authors, with an "all or nothing" rule. Three criteria were rather predominant: length of hospital stay, mortality, and need for hospital readmission, with variability in the times adopted by the authors for each criterion.

Our systematic review summarizes the international experience regarding the conceptualization of the TOLT to date. The impact of TOLT on graft and patient survival is debated, especially with the complexity of this surgery and its postoperative follow up. Multicenter studies are needed to achieve a standardization of TOLT on a global scale.