Avoiding ICU Admission by Using a Fast-Track Protocol Is Safe in Selected Adult-to-Adult Live Donor Liver Transplant Recipients
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 o...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2017-10-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000730 |
| _version_ | 1818909418717184000 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Juan Echeverri, MD |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-19T22:26:36Z |
| format | Article |
| id | doaj.art-b5f154b7775d4a4a998236f9c1110df6 |
| institution | Directory Open Access Journal |
| issn | 2373-8731 |
| language | English |
| last_indexed | 2024-12-19T22:26:36Z |
| publishDate | 2017-10-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj.art-b5f154b7775d4a4a998236f9c1110df62022-12-21T20:03:30ZengWolters KluwerTransplantation Direct2373-87312017-10-01310e21310.1097/TXD.0000000000000730201710000-0003Avoiding ICU Admission by Using a Fast-Track Protocol Is Safe in Selected Adult-to-Adult Live Donor Liver Transplant RecipientsJuan Echeverri, MD0Nicolas Goldaracena, MD1Akhil Kant Singh, MD2Gonzalo Sapisochin, MD3Nazia Selzner, MD4Mark S. Cattral, MD5Paul D. Greig, MD6Les Lilly, MD7Ian D. McGilvray, MD8Gary A. Levy, MD9Anand Ghanekar, MD10Eberhard L. Renner, MD11David R. Grant, MD12Stuart A. McCluskey, MD13Markus Selzner, MD141 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.2 Department of Anesthesia, Toronto General Hospital, University Health Network, Toronto, Canada.1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.3 Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Canada.1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.3 Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Canada.1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.3 Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Canada.1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.2 Department of Anesthesia, Toronto General Hospital, University Health Network, Toronto, Canada.1 Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.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.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000730 |
| spellingShingle | 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 Avoiding ICU Admission by Using a Fast-Track Protocol Is Safe in Selected Adult-to-Adult Live Donor Liver Transplant Recipients Transplantation Direct |
| title | Avoiding ICU Admission by Using a Fast-Track Protocol Is Safe in Selected Adult-to-Adult Live Donor Liver Transplant Recipients |
| title_full | Avoiding ICU Admission by Using a Fast-Track Protocol Is Safe in Selected Adult-to-Adult Live Donor Liver Transplant Recipients |
| title_fullStr | Avoiding ICU Admission by Using a Fast-Track Protocol Is Safe in Selected Adult-to-Adult Live Donor Liver Transplant Recipients |
| title_full_unstemmed | Avoiding ICU Admission by Using a Fast-Track Protocol Is Safe in Selected Adult-to-Adult Live Donor Liver Transplant Recipients |
| title_short | Avoiding ICU Admission by Using a Fast-Track Protocol Is Safe in Selected Adult-to-Adult Live Donor Liver Transplant Recipients |
| title_sort | avoiding icu admission by using a fast track protocol is safe in selected adult to adult live donor liver transplant recipients |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000730 |
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