Enhanced Recovery in Liver Transplantation: A Feasibility Study
Raffaele Brustia
Liver Transplantation Surgical Programme and Hepatobiliary Surgical Department, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l’Hôpital, Paris, France
Sorbonne Universités, Paris, France
Search for more papers by this authorAntoine Monsel
Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
Sorbonne Universités, Paris, France
Search for more papers by this authorFilomena Conti
Liver Transplantation and Hepatology Department, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l’Hôpital, 75013 Paris, France
Sorbonne Universités, Paris, France
Search for more papers by this authorEric Savier
Liver Transplantation Surgical Programme and Hepatobiliary Surgical Department, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l’Hôpital, Paris, France
Search for more papers by this authorGeraldine Rousseau
Liver Transplantation Surgical Programme and Hepatobiliary Surgical Department, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l’Hôpital, Paris, France
Sorbonne Universités, Paris, France
Search for more papers by this authorFabiano Perdigao
Liver Transplantation Surgical Programme and Hepatobiliary Surgical Department, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l’Hôpital, Paris, France
Search for more papers by this authorDenis Bernard
Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
Search for more papers by this authorDaniel Eyraud
Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
Search for more papers by this authorYann Loncar
Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
Search for more papers by this authorOlivier Langeron
Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
Sorbonne Universités, Paris, France
Search for more papers by this authorCorresponding Author
Olivier Scatton
- [email protected]
- + 33 (1) 42.17.56.52
Liver Transplantation Surgical Programme and Hepatobiliary Surgical Department, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l’Hôpital, Paris, France
Sorbonne Universités, Paris, France
Tel.: + 33 (1) 42.17.56.52, [email protected]Search for more papers by this authorRaffaele Brustia
Liver Transplantation Surgical Programme and Hepatobiliary Surgical Department, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l’Hôpital, Paris, France
Sorbonne Universités, Paris, France
Search for more papers by this authorAntoine Monsel
Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
Sorbonne Universités, Paris, France
Search for more papers by this authorFilomena Conti
Liver Transplantation and Hepatology Department, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l’Hôpital, 75013 Paris, France
Sorbonne Universités, Paris, France
Search for more papers by this authorEric Savier
Liver Transplantation Surgical Programme and Hepatobiliary Surgical Department, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l’Hôpital, Paris, France
Search for more papers by this authorGeraldine Rousseau
Liver Transplantation Surgical Programme and Hepatobiliary Surgical Department, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l’Hôpital, Paris, France
Sorbonne Universités, Paris, France
Search for more papers by this authorFabiano Perdigao
Liver Transplantation Surgical Programme and Hepatobiliary Surgical Department, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l’Hôpital, Paris, France
Search for more papers by this authorDenis Bernard
Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
Search for more papers by this authorDaniel Eyraud
Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
Search for more papers by this authorYann Loncar
Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
Search for more papers by this authorOlivier Langeron
Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
Sorbonne Universités, Paris, France
Search for more papers by this authorCorresponding Author
Olivier Scatton
- [email protected]
- + 33 (1) 42.17.56.52
Liver Transplantation Surgical Programme and Hepatobiliary Surgical Department, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l’Hôpital, Paris, France
Sorbonne Universités, Paris, France
Tel.: + 33 (1) 42.17.56.52, [email protected]Search for more papers by this authorElectronic supplementary material: The online version of this article (https://doi.org/10.1007/s00268-018-4747-y) contains supplementary material, which is available to authorized users.
Abstract
Background
Enhanced Recovery After Surgery (ERAS) programmes after surgery are effective in reducing length of stay, functional recovery and complication rates in liver surgery (LS) with the indirect advantage of reducing hospitalisation costs. Preoperative comorbidities, challenging surgical procedures and complex post-operative management are the points that liver transplantation (LT) shares with LS. Nevertheless, there is little evidence regarding the feasibility and safety of ERAS programmes in LT.
Methods
We designed a pilot, small-scale, feasibility study to assess the impact on hospital stay, protocol compliance and safety of an ERAS programme tailored for LT. The ERAS arm was compared with a 1:2 match paired control arm with similar characteristics. All patients with MELD <25 were included. A dedicated LT-tailored protocol was derived from publications on ERAS liver surgery.
Results
Ten patients were included in the Fast-Trans arm. It was observed a 47% reduction of the total LOS, as compared to the control arm: 9.5 (9.0–10.5) days versus 18.0 (14.3–24.3) days, respectively, p <0.001. The protocol achieved 72.9% compliance. No differences were observed in terms of post-operative complications or readmission rates after discharge between the two arms. Overall, it was observed a reduction of length of stay in ICU and surgical ward in the Fast-Trans arm compared with the control arm.
Conclusion
Considered the main points in common between LS and LT, this small-scale study suggests that the application of an ERAS programme tailored to the LT setting is feasible. Further testing will be appropriate to generalise these findings.
Supporting Information
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Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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