Enhanced recovery after low- and medium-risk liver transplantation. A single-center prospective observational cohort study.
Por:
Rodríguez-Laiz GP, Melgar P, Alcázar-López C, Franco-Campello M, Martínez-Adsuar F, Navarro-Martínez J, Gómez-Salinas L, Pascual S, Bellot P, Carnicer F, Rodríguez-Soler M, Palazón JM, Mas-Serrano P, Almanza-López S, Jaime-Sánchez F, Perdiguero M, de Santiago C, Lozano T, Irurzun J, Pérez E, Merino E, Zapater P and Lluís F
Publicada:
1 ene 2021
Ahead of Print:
15 dic 2020
Resumen:
BACKGROUND & AIMS: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: This single-center prospective observational cohort study provides evidence that ERAS is feasible and safe for low- and medium-risk LT.
Filiaciones:
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Hepatopancreatobiliary Surgery and Liver Transplantation, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Hepatopancreatobiliary Surgery and Liver Transplantation, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Hepatopancreatobiliary Surgery and Liver Transplantation, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Hepatopancreatobiliary Surgery and Liver Transplantation, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Anesthesiology and Surgical Critical Care, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Anesthesiology and Surgical Critical Care, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Anesthesiology and Surgical Critical Care, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Gastroenterology and Hepatology, General University Hospital of Alicante (HGUA), and Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Gastroenterology and Hepatology, General University Hospital of Alicante (HGUA), and Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Gastroenterology and Hepatology, General University Hospital of Alicante (HGUA), and Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Gastroenterology and Hepatology, General University Hospital of Alicante (HGUA), and Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Gastroenterology and Hepatology, General University Hospital of Alicante (HGUA), and Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Pharmacy and Pharmacokinetics, General University Hospital of Alicante (HGUA), and Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Critical Care Medicine, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Critical Care Medicine, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Nephrology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Transplant Coordination, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Cardiology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Radiology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Psychiatry, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Infectious Diseases, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Clinical Pharmacology, General University Hospital of Alicante (HGUA), and Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Hepatopancreatobiliary Surgery and Liver Transplantation, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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