Evaluation of textbook outcome in liver transplantation

The textbook outcome (TO) is a qualitative measurement tool for surgical procedures that has been tested in a multitude of cases. Liver transplantation (LT) is one of the most complex interventions in our specialty. In this study, we evaluate the achievement of TO in patients undergoing LT. We also propose a definition of specific TO for LT surgery.

A single-centre retrospective study was conducted between May 2012 and December 2022. Patients whose data were incomplete in the database, patients with retransplantation, transplants for acute liver failure, intraoperative findings of portal vein thrombosis, and patients who received a donor graft after circulatory death were excluded. TO was defined as the absence of mortality and major complications in the first 90 days after surgery, absence of readmission in the first 30 days, and a hospital stay not prolonged > p75.

A total of 132 patients were included. More than half achieved TO (56.8%). Prolonged hospital stay was the variable that most limited the achievement of TO (25% of patients). Pre-transplant hypertension in the recipient and prolonged cold ischaemia time were associated with a lower rate of TO. Survival was higher in the group that achieved TO, although statistical significance could not be demonstrated.

TO is a valuable measure for assessing LT. A universal definition of TO for LT will be necessary given the lack of consensus on the criteria used among the different series published to date.