Avoiding ICU Admission by Using a Fast-Track Protocol Is Safe in Selected Adult-to-Adult Live Donor Liver Transplant Recipients

Juan Echeverri, MD; Nicolas Goldaracena, MD; Akhil Kant Singh, MD; Gonzalo Sapisochin, MD; Nazia Selzner, MD; Mark S. Cattral, MD; Paul D. Greig, MD; Les Lilly, MD; Ian D. McGilvray, MD; Gary A. Levy, MD; Anand Ghanekar, MD; Eberhard L. Renner, MD; David R. Grant, MD; Stuart A. McCluskey, MD; Markus Selzner, MD

doi:10.1097/TXD.0000000000000730

Transplantation Direct (Oct 2017)

Avoiding ICU Admission by Using a Fast-Track Protocol Is Safe in Selected Adult-to-Adult Live Donor Liver Transplant Recipients

Juan Echeverri, MD,
Nicolas Goldaracena, MD,
Akhil Kant Singh, MD,
Gonzalo Sapisochin, MD,
Nazia Selzner, MD,
Mark S. Cattral, MD,
Paul D. Greig, MD,
Les Lilly, MD,
Ian D. McGilvray, MD,
Gary A. Levy, MD,
Anand Ghanekar, MD,
Eberhard L. Renner, MD,
David R. Grant, MD,
Stuart A. McCluskey, MD,
Markus Selzner, MD

Affiliations

Juan Echeverri, MD: 1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.
Nicolas Goldaracena, MD: 1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.
Akhil Kant Singh, MD: 2 Department of Anesthesia, Toronto General Hospital, University Health Network, Toronto, Canada.
Gonzalo Sapisochin, MD: 1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.
Nazia Selzner, MD: 3 Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Canada.
Mark S. Cattral, MD: 1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.
Paul D. Greig, MD: 1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.
Les Lilly, MD: 3 Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Canada.
Ian D. McGilvray, MD: 1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.
Gary A. Levy, MD: 1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.
Anand Ghanekar, MD: 1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.
Eberhard L. Renner, MD: 3 Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Canada.
David R. Grant, MD: 1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.
Stuart A. McCluskey, MD: 2 Department of Anesthesia, Toronto General Hospital, University Health Network, Toronto, Canada.
Markus Selzner, MD: 1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.

DOI: https://doi.org/10.1097/TXD.0000000000000730
Journal volume & issue: Vol. 3, no. 10
p. e213

Abstract

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Background. We evaluated patient characteristics of live donor liver transplant (LDLT) recipients undergoing a fast-track protocol without intensive care unit (ICU) admission versus LDLT patients receiving posttransplant ICU care. Methods. Of the 153 LDLT recipients, 46 patients were included in our fast-track protocol without ICU admission. Both, fast-tracked patients and ICU-admitted patients were compared regarding donor and patient characteristics, perioperative characteristics, and postoperative outcomes and complications. In a subgroup analysis, we compared fast-tracked patients with patients who were admitted in the ICU for less than 24 hours. Results. Fast-tracked versus ICU patients had a lower model for end-stage liver disease score (13 ± 4 vs 18 ± 7; P < 0.0001), lower preoperative bilirubin levels (51 ± 50 μmol/L vs 119.4 ± 137.3 μmol/L; P < 0.001), required fewer units of packed red blood cells (1.7 ± 1.78 vs 4.4 ± 4; P < 0.0001), and less fresh-frozen plasma (2.7 ± 2 vs 5.8 ± 5; P < 0.0001) during transplantation. Regarding postoperative outcomes, fast-tracked patients presented fewer bacterial infections within 30 days (6.5% [3] vs 29% [28]; P = 0.002), no episodes of pneumonia (0% vs 11.3% [11]; P = 0.02), and less biliary complications within the first year (6% [3] vs 26% [25]; P = 0.001). Also, fast-tracked patients had a shorter posttransplant hospital stay (10.8 ± 5 vs 21.3 ± 29; P = 0.002). In the subgroup analysis, fast-tracked vs ICU patients admitted for less than 24 hours had lower requirements of packed red blood cells (1.7 ± 1.78 vs 3.9 ± 4; P = 0.001) and fresh-frozen plasma (2.7 ± 2 vs 5.8 ± 4.5; P = 0.0001). Conclusions. Fast-track of selected patients after LDLT is safe and feasible. An objective score to perioperatively select LDLT recipients amenable to fast track is yet to be determined.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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