[en] 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 RCTs on LT in the last 15 years. Studies were selected by 5 independent reviewers, and were eligible if focusing on each validated ERAS items 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. 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.PROSPERO CRD4201913279.
Disciplines :
Surgery Gastroenterology & hepatology Anesthesia & intensive care
Author, co-author :
Brustia, Raffaele
Monsel, Antoine
Skurzak, Stefano
Schiffer, Eduardo
Carrier, François Martin
Patrono, Damiano
KABA, Abdourahmane ; Centre Hospitalier Universitaire de Liège - CHU > Département d'Anesthésie et réanimation > Service d'anesthésie - réanimation
Detry, Olivier ; Université de Liège - ULiège > Département des sciences cliniques > Pathologie chirurgicale abdominale et endocrinienne
Ljungqvist O, Scott M, Fearon KC,. Enhanced Recovery After Surgery: a review. JAMA Surg. 2017; 152: 292-298.
Gustafsson UO, Scott MJ, Schwenk W, 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.
Melloul E, Lassen K, Roulin D,. Guidelines for perioperative care for pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) recommendations 2019. World J Surg. 2020; 44: 2056-2084.
Melloul E, Hübner M, Scott M,. Guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) society recommendations. World J Surg. 2016; 40: 2425-2440.
Lau CS, Chamberlain RS,. Enhanced Recovery After Surgery programs improve patient outcomes and recovery: a meta-analysis. World J Surg. 2017; 41: 899-913.
Adam R, Karam V, Delvart V, All contributing centers (www.eltr.org); European Liver and Intestine Transplant Association (ELITA). Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol. 2012; 57: 675-688.
Adam R, Delvart V, Karam V,. Compared efficacy of preservation solutions in liver transplantation: a long-term graft outcome study from the European Liver Transplant Registry. Am J Transplant. 2015; 15: 395-406.
Adam R, Karam V, Cailliez V, all the other 126 contributing centers (www.eltr.org) and the European Liver and Intestine Transplant Association (ELITA). 2018 annual report of the European Liver Transplant Registry (ELTR)-50-year evolution of liver transplantation. Transpl Int. 2018; 31: 1293-1317.
Rana A, Ackah RL, Webb GJ,. No gains in long-term survival after liver transplantation over the past three decades. Ann Surg. 2019; 269: 20-27.
Montano-Loza AJ, Meza-Junco J, Prado CM,. Muscle wasting is associated with mortality in patients with cirrhosis. Clin Gastroenterol Hepatol. 2012; 10: 166-73, 173.e1.
Mourad MM, Liossis C, Gunson BK,. Etiology and management of hepatic artery thrombosis after adult liver transplantation. Liver Transpl. 2014; 20: 713-723.
Axelrod DA, Lentine KL, Xiao H,. National assessment of early biliary complications following liver transplantation: incidence and outcomes. Liver Transpl. 2014; 20: 446-456.
Zhang W, Fung J,. Limitations of current liver transplant immunosuppressive regimens: renal considerations. Hepatobiliary Pancreat Dis Int. 2017; 16: 27-32.
Daugaard TR, Pommergaard HC, Rostved AA,. Postoperative complications as a predictor for survival after liver transplantation.-proposition of a prognostic score. HPB. 2018; 20: 815-822.
Brustia R, Monsel A, Conti F,. Enhanced recovery in liver transplantation: a feasibility Study. World J Surg. 2019; 43: 230-241.
Rao JH, Zhang F, Lu H,. Effects of multimodal fast-track surgery on liver transplantation outcomes. Hepatobiliary Pancreat Dis Int. 2017; 16: 364-369.
Brindle M, Nelson G, Lobo DN,. Recommendations from the ERAS® Society for standards for the development of Enhanced Recovery After Surgery guidelines. BJS Open. 2020; 4: 157-163.
Brouwers MC, Kerkvliet K, Spithoff K, AGREE Next Steps Consortium. The AGREE reporting checklist: a tool to improve reporting of clinical practice guidelines. BMJ. 2016; 352: i1152.
Abeles A, Kwasnicki RM, Darzi A,. Enhanced Recovery After Surgery: current research insights and future direction. World J Gastrointest Surg. 2017; 9: 37-45.
Lassen K, Coolsen MM, Slim K, ERAS® Society; European Society for Clinical Nutrition and Metabolism; International Association for Surgical Metabolism and Nutrition. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Clin Nutr. 2012; 31: 817-830.
Brustia R, Dechartres A, Scatton O,. A methodological review of clinical outcomes reported in liver transplantation trials. HPB (Oxford). 2020; 22: 833-844.
Ouzzani M, Hammady H, Fedorowicz Z,. Rayyan.-a web and mobile app for systematic reviews. Syst Rev. 2016; 5: 210.
Higgins JP, Altman DG, Gøtzsche PC, Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011; 343: d5928.
Jadad AR, Moore RA, Carroll D,. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996; 17: 1-12.
Guyatt GH, Oxman AD, Vist GE,. Rating quality of evidence and strength of recommendations: GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Br Med J. 2008; 336: 924.
Liberati A, Altman DG, Tetzlaff J,. The PRISMA statement for reporting Systematic Reviews and Meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339: b2700.
Booth A, Clarke M, Ghersi D,. An international registry of systematic-review protocols. Lancet (London, England). 2011; 377: 108-109.
Centre for Evidence-based Medicine. Oxford Centre for Evidence-based Medicine: Levels of Evidence (March 2009). Available at https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Accessed September 5, 2019.
Bischoff SC, Singer P, Koller M,. Standard operating procedures for ESPEN guidelines and consensus papers. Clin Nutr. 2015; 34: 1043-1051.
Hsu C-C, Sandford BA. The Delphi technique: making sense of consensus. Pract assess res eval. 2007; 12: 10.
Rowe G, Wright G,. The Delphi technique as a forecasting tool: issues and analysis. Int J Forecast. 1999; 15: 353-375.
Murphy MK, Black NA, Lamping DL,. Consensus development methods, and their use in clinical guideline development. Health Technol Assess. 1998; 2: i-iv, 1.
Donohoe H, Stellefson M, Tennant B,. Advantages and limitations of the e-Delphi technique: implications for health education researchers. Am J Health Educ. 2012; 43: 38-46.
Pomery A, Schofield P, Xhilaga M,. Pragmatic, consensus-based minimum standards and structured interview to guide the selection and development of cancer support group leaders: a protocol paper. BMJ Open. 2017; 7: e014408.
Blaschke S, O'Callaghan CC, Schofield P,. Nature-based care opportunities and barriers in oncology contexts: a modified international e-Delphi survey. BMJ Open. 2017; 7:e 017456.
Boulkedid R, Abdoul H, Loustau M,. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PLoS One. 2011; 6:e 20476.
Reese PP, Yeh H, Thomasson AM,. Transplant center volume and outcomes after liver retransplantation. Am J Transplant. 2009; 9: 309-317.
Bailey MD, Godfrey EL, Frankel WC,. A data-driven approach to defining the volume-outcome relationship in liver transplantation. Available at https://atcmeetingabstracts.com/abstract/a-data-driven-approach-to-defining-the-volume-outcome-relationship-in-liver-transplantation/. Accessed October 13, 2020.
Macomber CW, Shaw JJ, Santry H,. Centre volume and resource consumption in liver transplantation. HPB (Oxford). 2012; 14: 554-559.
Brustia R, Boleslawski E, Monsel A, Groupe de Recherche Français en Greffe de Foie (GReF2) and the Association de Chirurgie Hépato-Pancréato-Biliaire et Transplantation (ACHBT) Collaborative Group. Definition and prospective assessment of functional recovery after liver transplantation: a new objective consensus-based metric for safe discharge. Liver Transpl. 2020; 26: 1241-1253.
Muller X, Marcon F, Sapisochin G,. Defining benchmarks in liver transplantation: a multicenter outcome analysis determining best achievable results. Ann Surg. 2018; 267: 419-425.
Volk ML, Roney M, Fagerlin A,. Pilot test of a patient decision aid about liver transplant organ quality. Liver Transpl. 2014; 20: 850-855.
Op den Dries S, Annema C, Berg AP,. Shared decision making in transplantation: how patients see their role in the decision process of accepting a donor liver. Liver Transpl. 2014; 20: 1072-1080.
Brustia R, Savier E, Scatton O,. Physical exercise in cirrhotic patients: towards prehabilitation on waiting list for liver transplantation. A systematic review and meta-analysis. Clin Res Hepatol Gastroenterol. 2018; 42: 205-215.
Aamann L, Dam G, Rinnov AR,. Physical exercise for people with cirrhosis. Cochrane Database Syst Rev. 2018; 12: CD012678.
Plauth M, Bernal W, Dasarathy S,. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr. 2019; 38: 485-521.
Tandon P, Raman M, Mourtzakis M,. A practical approach to nutritional screening and assessment in cirrhosis. Hepatology. 2017; 65: 1044-1057.
Grąt M, Wronka KM, Lewandowski Z,. Effects of continuous use of probiotics before liver transplantation: a randomized, double-blind, placebo-controlled trial. Clin Nutr. 2017; 36: 1530-1539.
Lei Q, Wang X, Zheng H,. Peri-operative immunonutrition in patients undergoing liver transplantation: a meta-analysis of randomized controlled trials. Asia Pac J Clin Nutr. 2015; 24: 583-590.
Smith MD, Mccall J, Plank L,. Preoperative carbohydrate treatment for enhancing recovery after elective surgery. Cochrane Database Syst Rev. 2014; 8: CD009161.
Berry PS, Rosenberger LH, Guidry CA,. Intraoperative versus extended antibiotic prophylaxis in liver transplant surgery: a Randomized Controlled Pilot Trial. Liver Transpl. 2019; 25: 1043-1053.
Gurusamy KS, Nagendran M, Davidson BR,. Methods of preventing bacterial sepsis and wound complications after liver transplantation. Cochrane Database Syst Rev. 2014; 4: CD006660.
Pratschke S, Rauch A, Albertsmeier M,. Temporary intraoperative porto-caval shunts in piggy-back liver transplantation reduce intraoperative blood loss and improve postoperative transaminases and renal function: a meta-analysis. World J Surg. 2016; 40: 2988-2998.
Nacif LS, Zanini LY, Sartori VF,. Intraoperative surgical portosystemic shunt in liver transplantation: systematic review and meta-analysis. Ann Transplant. 2018; 23: 721-732.
Lee J, Yoo YJ, Lee JM,. Sevoflurane versus desflurane on the incidence of postreperfusion syndrome during living donor liver transplantation: a Randomized Controlled Trial. Transplantation. 2016; 100: 600-606.
Milan ZB, Duncan B, Rewari V,. Subcostal transversus abdominis plane block for postoperative analgesia in liver transplant recipients. Transplant Proc. 2011; 43: 2687-2690.
Tong K, Nolan W, O'Sullivan DM,. Implementation of a multimodal pain management order set reduces perioperative opioid use after liver transplantation. Pharmacotherapy. 2019; 39: 975-982.
Li J, Wang C, Jiang Y,. Immediate versus conventional postoperative tracheal extubation for enhanced recovery after liver transplantation IPTE versus CTE for enhanced recovery after liver transplantation. Med (United States). 2018; 97: e13082.
Skurzak S, Stratta C, Schellino MM,. Extubation score in the operating room after liver transplantation. Acta Anaesthesiol Scand. 2010; 54: 970-978.
Bulatao IG, Heckman MG, Rawal B,. Avoiding stay in the intensive care unit after liver transplantation: a score to assign location of care. Am J Transplant. 2014; 14: 2088-2096.
Carrier FM, Chassé M, Wang HT,. Restrictive fluid management strategies and outcomes in liver transplantation: a systematic review. Can J Anaesth. 2020; 67: 109-127.
Weinberg L, Huang A, Alban D,. Prevention of hypothermia in patients undergoing orthotopic liver transplantation using the Humigard® open surgery humidification system: a prospective randomized pilot and feasibility clinical trial. BMC Surg. 2017; 17: 10.
Janicki PK, Stoica C, Chapman WC,. Water warming garment versus forced air warming system in prevention of intraoperative hypothermia during liver transplantation: a randomized controlled trial [ISRCTN32154832]. BMC Anesthesiol. 2002; 2: 7.
Kamo N, Kaido T, Hamaguchi Y,. Impact of enteral nutrition with an immunomodulating diet enriched with hydrolyzed whey peptide on infection after liver transplantation. World J Surg. 2018; 42: 3715-3725.
Maffei P, Wiramus S, Bensoussan L,. Intensive early rehabilitation in the intensive care unit for liver transplant recipients: a Randomized Controlled Trial. Arch Phys Med Rehabil. 2017; 98: 1518-1525.
Schaller SJ, Anstey M, Blobner M, International Early SOMS-guided Mobilization Research Initiative. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet. 2016; 388: 1377-1388.
Park C, Hsu C, Neelakanta G,. Severe intraoperative hyperglycemia is independently associated with surgical site infection after liver transplantation. Transplantation. 2009; 87: 1031-1036.
Wallia A, Parikh ND, Molitch ME,. Posttransplant hyperglycemia is associated with increased risk of liver allograft rejection. Transplantation. 2010; 89: 222-226.
Wallia A, Parikh ND, O'Shea-Mahler E,. Glycemic control by a glucose management service and infection rates after liver transplantation. Endocr Pract. 2011; 17: 546-551.
Wallia A, Schmidt K, Oakes DJ,. Glycemic control reduces infections in post-liver transplant patients: results of a prospective, Randomized Study. J Clin Endocrinol Metab. 2017; 102: 451-459.
Bardet JD, Charpiat B, Bedouch P,. Illness representation and treatment beliefs in liver transplantation: an exploratory qualitative study. Ann Pharm Fr. 2014; 72: 375-387.
Asavakarn S, Sirivatanauksorn Y, Promraj R,. Systematic pharmaceutical educational approach to enhance drug adherence in liver transplant recipients. Transplant Proc. 2016; 48: 1202-1207.
Ko D, Lee I, Muehrer RJ,. Informational needs of liver transplant recipients during a two-year posttransplant period. Chronic Illn. 2016; 12: 29-40.
