Practice Guideline

. 2022 Mar 1;106(3):552-561.

doi: 10.1097/TP.0000000000003808.

Guidelines for Perioperative Care for Liver Transplantation: Enhanced Recovery After Surgery (ERAS) Recommendations

Raffaele Brustia^{1

2}, Antoine Monsel^{3

4

5}, Stefano Skurzak⁶, Eduardo Schiffer⁷, François Martin Carrier^{8

9

10}, Damiano Patrono¹¹, Abdourahamane Kaba¹², Olivier Detry¹³, Luiz Malbouisson¹⁴, Wellington Andraus¹⁵, Franck Vandenbroucke-Menu¹⁶, Gianni Biancofiore¹⁷, Toshimi Kaido¹⁸, Philippe Compagnon¹⁹, Shinji Uemoto¹⁸, Gonzalo Rodriguez Laiz²⁰, Marieke De Boer²¹, Susan Orloff²², Paola Melgar²⁰, Carlijn Buis²¹, Miriam Zeillemaker-Hoekstra²³, Helen Usher²⁴, Koen Reyntjens²⁵, Emily Baird²⁶, Nicolas Demartines²⁷, Stephen Wigmore²⁸, Olivier Scatton²⁹

Affiliations

¹ Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France.
² Research Unit, Université de Picardie-Jules Verne, UR UPJV 7518 SSPC, Amiens, France.
³ Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France.
⁴ Immunology-Immunopathology-Immunotherapy (I3), Sorbonne Université, INSERM, UMR-S 959, Paris, France.
⁵ Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.
⁶ Department of Anesthesiology and Critical Care, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.
⁷ Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva, Switzerland.
⁸ University of Montreal Hospital Center Research Center, Montreal, QC, Canada.
⁹ Department of Anesthesiology, University of Montreal Hospital Centre, Montreal, QC, Canada.
¹⁰ Division of Critical Care, Department of Medicine, University of Montreal Hospital Centre, Montreal, QC, Canada.
¹¹ General Surgery 2U-Liver Transplant Unit, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Corso Bramante, Torino, Italy.
¹² Department of Anaesthesiology (AMH, A-SJM, AK, JLJ), Service of Abdominal Surgery, CHU Liège, University of Liège, Domaine du Sart Tilman, Liège, Belgium.
¹³ Division of Abdominal Surgery and Transplantation, University of Liège Hospital (CHU ULiège), Liège, Belgium.
¹⁴ Anesthesiology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
¹⁵ Digestive Organs Transplant Division, Gastroenterology Department, Sao Paulo University School of Medicine, Sao Paulo, Brazil.
¹⁶ HPB Surgery and Liver Transplantation Unit, CHUM University of Montreal, Montreal, QC, Canada.
¹⁷ Transplant Anesthesia and Critical Care Unit, University School of Medicine, Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy.
¹⁸ Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
¹⁹ Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
²⁰ Department of General & Digestive Surgery, Instituto de Investigación Sanitaria y Biomédica de Alicante, Hospital General Universitario de Alicante, Alicante, Spain.
²¹ Section Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
²² Division of Abdominal Organ Transplantation, Department of Surgery, Oregon Health & Science University, Portland, OR.
²³ Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
²⁴ Department of Anesthesiology and Critical Care, Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
²⁵ Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
²⁶ Department of Anesthesiology and Critical Care, Oregon Health & Science University, Portland, OR.
²⁷ Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne UNIL, Rue du Bugnon, Lausanne, Switzerland.
²⁸ Department of Clinical Surgery, University of Edinburgh and Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
²⁹ Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtriere, Sorbonne Université, Centre de Recherche de Saint-Antoine (CRSA), INSERM, Paris, France.

PMID: 33966024
DOI: 10.1097/TP.0000000000003808

Free article

Practice Guideline

Guidelines for Perioperative Care for Liver Transplantation: Enhanced Recovery After Surgery (ERAS) Recommendations

Raffaele Brustia et al. Transplantation. 2022.

Free article

. 2022 Mar 1;106(3):552-561.

doi: 10.1097/TP.0000000000003808.

Authors

Affiliations

¹ Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Hôpital de la Pitié-Salpêtrière, Paris, France.
² Research Unit, Université de Picardie-Jules Verne, UR UPJV 7518 SSPC, Amiens, France.
³ Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France.
⁴ Immunology-Immunopathology-Immunotherapy (I3), Sorbonne Université, INSERM, UMR-S 959, Paris, France.
⁵ Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.
⁶ Department of Anesthesiology and Critical Care, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.
⁷ Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva, Switzerland.
⁸ University of Montreal Hospital Center Research Center, Montreal, QC, Canada.
⁹ Department of Anesthesiology, University of Montreal Hospital Centre, Montreal, QC, Canada.
¹⁰ Division of Critical Care, Department of Medicine, University of Montreal Hospital Centre, Montreal, QC, Canada.
¹¹ General Surgery 2U-Liver Transplant Unit, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Corso Bramante, Torino, Italy.
¹² Department of Anaesthesiology (AMH, A-SJM, AK, JLJ), Service of Abdominal Surgery, CHU Liège, University of Liège, Domaine du Sart Tilman, Liège, Belgium.
¹³ Division of Abdominal Surgery and Transplantation, University of Liège Hospital (CHU ULiège), Liège, Belgium.
¹⁴ Anesthesiology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
¹⁵ Digestive Organs Transplant Division, Gastroenterology Department, Sao Paulo University School of Medicine, Sao Paulo, Brazil.
¹⁶ HPB Surgery and Liver Transplantation Unit, CHUM University of Montreal, Montreal, QC, Canada.
¹⁷ Transplant Anesthesia and Critical Care Unit, University School of Medicine, Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy.
¹⁸ Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
¹⁹ Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
²⁰ Department of General & Digestive Surgery, Instituto de Investigación Sanitaria y Biomédica de Alicante, Hospital General Universitario de Alicante, Alicante, Spain.
²¹ Section Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
²² Division of Abdominal Organ Transplantation, Department of Surgery, Oregon Health & Science University, Portland, OR.
²³ Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
²⁴ Department of Anesthesiology and Critical Care, Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
²⁵ Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
²⁶ Department of Anesthesiology and Critical Care, Oregon Health & Science University, Portland, OR.
²⁷ Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne UNIL, Rue du Bugnon, Lausanne, Switzerland.
²⁸ Department of Clinical Surgery, University of Edinburgh and Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
²⁹ Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtriere, Sorbonne Université, Centre de Recherche de Saint-Antoine (CRSA), INSERM, Paris, France.

PMID: 33966024
DOI: 10.1097/TP.0000000000003808

Abstract

Background: Enhanced Recovery After Surgery (ERAS) is a multimodal, evidence-based, program of care developed to minimize the response to surgical stress, associated with reduced perioperative morbidity and hospital stay. This study presents the specific ERAS Society recommendations for liver transplantation (LT) based on the best available evidence and on expert consensus.

Methods: PubMed and ClinicalTrials.gov were searched in April 2019 for published and ongoing randomized clinical trials on LT in the last 15 y. Studies were selected by 5 independent reviewers and were eligible if focusing on each validated ERAS item in the area of adult LT. An e-Delphi method was used with an extended interdisciplinary panel of experts to validate the final recommendations.

Results: Forty-three articles were included in the systematic review. A consensus was reached among experts after the second round. Patients should be screened for malnutrition and treated whenever possible. Prophylactic nasogastric intubation and prophylactic abdominal drainage may be omitted, and early extubation should be considered. Early oral intake, mobilization, and multimodal-balanced analgesia are recommended.

Conclusions: The current ERAS recommendations were elaborated based on the best available evidence and endorsed by the e-Delphi method. Nevertheless, prospective studies need to confirm the clinical use of the suggested protocol.

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Conflict of interest statement

The authors declare no conflicts of interest.

Comment in

Enhanced Recovery for Liver Transplantation: A First Step on a Long Road.
Sellers D, Sapisochin G, Selzner N, McCluskey SA. Sellers D, et al. Transplantation. 2022 Mar 1;106(3):460-461. doi: 10.1097/TP.0000000000003809. Transplantation. 2022. PMID: 33966026 No abstract available.

References

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1. Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: a review. JAMA Surg. 2017;152:292–298.
1. Gustafsson UO, Scott MJ, Schwenk W, et al.; Enhanced Recovery After Surgery Society. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr. 2012;31:783–800.
1. Melloul E, Lassen K, Roulin D, et al. Guidelines for perioperative care for pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) recommendations 2019. World J Surg. 2020;44:2056–2084.
1. Melloul E, Hübner M, Scott M, et al. Guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) society recommendations. World J Surg. 2016;40:2425–2440.

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Guidelines for Perioperative Care for Liver Transplantation: Enhanced Recovery After Surgery (ERAS) Recommendations

Affiliations

Guidelines for Perioperative Care for Liver Transplantation: Enhanced Recovery After Surgery (ERAS) Recommendations

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Miscellaneous