Textbook outcome among patients undergoing enhanced recovery after liver transplantation stratified by risk. A single-center retrospective observational cohort study. (March 2022)

• Record Type: Journal Article
• Authors: Melgar, Paola; Rodríguez-Laiz, Gonzalo P.; Lluís, Núria; Alcázar-López, Cándido; Franco-Campello, Mariano; Villodre, Celia; Pascual, Sonia; Rodríguez-Soler, María; Bellot, Pau; Miralles, Cayetano; Perdiguero, Miguel; Díaz, María; Mas-Serrano, Patricio; Zapater, Pedro; Ramia, José Manuel; Lluís, Félix
• Is Part Of: International journal of surgery. Volume 99(2022)
• Publication Date: 2022-03
• Subjects: Enhanced recovery after surgery -- Liver transplantation -- Textbook outcome -- Tacrolimus -- Estimated glomerular filtration rate -- Chronic kidney disease; AUC area under the curve -- BAR balance of risk -- CDK chronic kidney disease -- eGFR estimated glomerular filtration rate -- ERAS enhanced recovery after surgery -- HCC hepatocellular carcinoma -- HCV hepatitis C virus -- ICU intensive care unit -- IQR interquartile range -- LT liver transplantation -- MELD model for end-stage liver disease -- pRBC packed red blood cells -- TO textbook outcome; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2022.106266
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Background & aims: Liver transplantation (LT) is one of the most complex surgical procedures. Enhanced recovery after surgery (ERAS) aims to reduce the risk of postoperative complications. When patients achieve all desirable outcomes after a procedure, they are considered to have experienced a textbook outcome (TO). Methods: Two cohorts of patients undergoing low (n = 101) or medium risk (n = 15) LT were identified. The remaining patients (n = 65) were grouped separately. The ERAS protocol included pre-, intra-, and post-operative steps. TO was defined as the absence of complications, prolonged length of hospital stays, readmission and mortality during the first 90 days. Results: One third of patients who underwent ERAS after LT experienced a TO. On multivariable analysis, age (OR, 1.05 [95% CI, 1.01–1.09]; P = .02), and having hepatocellular carcinoma (OR, 2.83 [95% CI, 1.37–6.03]; P = .005) were individually associated with a greater probability of achieving a TO. Belonging to the cohorts of medium risk or outside the selection criteria was associated with a lower probability of achieving a TO (OR, 0.46 [96% CI, 0.22–0.93]; P = .03). Patients less likely to experience TO required more hospital resources. Patients who achieved TO were more likely to remain free of chronic kidney disease (achieved TO, 83.8% [82.7–85.6]; failed TO, 67.9% [66.9–70.2]; P < .05). Tacrolimus dose and trough levels were similar. Conclusions: A novel finding of our study is that short and medium-term kidney function is better preserved in patients who experience a TO. Better kidney function of patients who achieve TO is not due to lower tacrolimus dosage. Highlights: One in three patients achieve textbook outcome after liver transplantation Achievement of textbook outcome entails a reduction of costs Patients who experience textbook outcome are more likely to maintain kidney function Dose of tacrolimus is similar among patients who fail or achieve textbook outcome Better kidney function is not due to lower dose of tacrolimus in these patients