Effects of multimodal fast-track surgery on liver transplantation outcomes

Jian-Hua Rao; Feng Zhang; Hao Lu; Xin-Zheng Dai; Chuan-Yong Zhang; Xiao-Feng Qian; Xue-Hao Wang; Ling Lu

doi:10.1016/S1499-3872(17)60020-1

Effects of multimodal fast-track surgery on liver transplantation outcomes

Hepatobiliary Pancreat Dis Int. 2017 Aug 15;16(4):364-369. doi: 10.1016/S1499-3872(17)60020-1.

Authors

Jian-Hua Rao¹, Feng Zhang¹, Hao Lu¹, Xin-Zheng Dai¹, Chuan-Yong Zhang¹, Xiao-Feng Qian¹, Xue-Hao Wang¹, Ling Lu²

Affiliations

¹ Liver Transplantation Center, First Affiliated Hospital of Nanjing Medical University; Key Laboratory of Living Donor Liver Transplantation of Ministry of Public Health, Nanjing 210029, China.
² Liver Transplantation Center, First Affiliated Hospital of Nanjing Medical University; Key Laboratory of Living Donor Liver Transplantation of Ministry of Public Health, Nanjing 210029, China. Electronic address: lvling@njmu.edu.cn.

PMID: 28823365
DOI: 10.1016/S1499-3872(17)60020-1

Abstract

Background: Fast-track surgery and enhanced recovery after surgery have been applied to many surgical procedures; however, data on fast-track surgery and enhanced recovery after surgery following liver transplantation is limited. This study aimed to conduct a prospective study to determine the effects of fast-track surgery on prognosis after liver transplantation.

Methods: This was a prospective, single-blinded, randomized study. One hundred twenty-eight patients undergoing liver transplantation were selected for the fast-track (FT group, n=54) or conventional process (NFT group, n=74). The primary endpoints were intensive care unit (ICU) stay and hospital stay. The secondary endpoints were as follows: operative time, anhepatic phase time, intraoperative blood loss, intraoperative blood transfusion volume, postoperative complications, readmission rate, and postoperative mortality.

Results: There was no significant difference in preoperative demographics between the two groups. The median ICU stay was 2 days (range 1-7 days) in the FT group and 5 days (range 3-12 days) in the NFT group (P<0.01). Furthermore, the hospital stay was also significantly reduced in the FT group (P<0.01). The operative time, anhepatic phase time, intraoperative blood loss, and intraoperative blood transfusion volume were decreased in the FT group compared with the NFT group (P<0.05). Based on Spearman correlation analysis, the ICU stay and hospital stay may be positively correlated with operative time, anhepatic phase time and intraoperative blood loss. There were no differences in the incidence of postoperative complications, readmissions, and postoperative mortality between the two groups.

Conclusion: Fast-track procedures effectively reduce the ICU stay and hospital stay without adversely affecting prognosis. This study demonstrated that fast-track protocols are safe and feasible in liver transplantation.

Keywords: ICU days; fast-track surgery; hospital stay; liver transplantation; surgical drainage.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Aged
Blood Loss, Surgical
China
End Stage Liver Disease / diagnosis
End Stage Liver Disease / etiology
End Stage Liver Disease / mortality
End Stage Liver Disease / surgery*
Female
Humans
Intensive Care Units
Length of Stay*
Liver Transplantation / adverse effects
Liver Transplantation / methods*
Liver Transplantation / mortality
Male
Middle Aged
Operative Time
Patient Readmission
Postoperative Complications / etiology
Prospective Studies
Recovery of Function
Single-Blind Method
Time Factors
Treatment Outcome