Enhanced recovery after low- and medium-risk liver transplantation. A single-center prospective observational cohort study

• Published in: International journal of surgery (London, England) Vol. 85; pp. 46 - 54
• Main Authors: Rodríguez-Laiz, Gonzalo P., Melgar, Paola, Alcázar-López, Cándido, Franco-Campello, Mariano, Martínez-Adsuar, Francisco, Navarro-Martínez, José, Gómez-Salinas, Luís, Pascual, Sonia, Bellot, Pau, Carnicer, Fernando, Rodríguez-Soler, María, Palazón, José M., Mas-Serrano, Patricio, Almanza-López, Susana, Jaime-Sánchez, Francisco, Perdiguero, Miguel, de Santiago, Carlos, Lozano, Teresa, Irurzun, Javier, Pérez, Enrique, Merino, Esperanza, Zapater, Pedro, Lluís, Félix
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.01.2021
• Subjects: Aged; Enhanced Recovery After Surgery; Female; Humans; Liver transplantation; Liver Transplantation - adverse effects; Male; Middle Aged; Outcome; Prospective Studies; Risk Factors; CCI; LT; HCC; IQR; CMV; BAR; MELD; Outcome; pRBC; Enhanced recovery after surgery; ICU; Liver transplantation; ERAS
• ISSN: 1743-9191; 1743-9159
• DOI: 10.1016/j.ijsu.2020.12.003

Few studies have fully applied an enhanced recovery after surgery (ERAS) protocol to liver transplantation (LT). Our aim was to assess the effects of a comprehensive ERAS protocol in our cohort of low- and medium-risk LT patients. The ERAS protocol included pre-, intra-, and post-operative steps. During the five-year study period, 181 LT were performed in our institution. Two cohorts were identified: low risk patients (n = 101) had a laboratory model for end-stage liver disease (MELD) score of 20 points or less at the time of LT, received a liver from a donor after brain death, and had a balance of risk score of 9 points or less; medium-risk patients (n = 15) had identical characteristics except for a higher MELD score (21–30 points). In addition, we analyzed the remaining patients (n = 65) who were transplanted over the same study period separately using the ERAS protocol. The low-risk cohort showed a low need for packed red blood cells transfusion (median: 0 units) and renal replacement therapy (1%), as well as a short length of stay both in the intensive care unit (13 h) and in the hospital (4 days); morbidity during one-year follow-up, and probability of surviving to one year (89.30%) and five years (76.99%) were in line with well-established reference data. Similar findings were observed in the medium-risk cohort. This single-center prospective observational cohort study provides evidence that ERAS is feasible and safe for low- and medium-risk LT. •Enhanced recovery after low- and middle-risk liver transplantation is feasible and safe.•Adherence to enhanced recovery items is high in both cohorts.•Need for red blood cell transfusion and renal replacement therapy is low.•Length of stay in the intensive care unit and in the hospital are short.•Morbidity and mortality are similar to well established reference data.