Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference

Pollok, Joerg M.; Berenguer, Marina; Niemann, Claus U.; Raptis, Dimitri Aristotle; Spiro, Michael; Mayr, Andreas; Domı́nguez, Beatriz; Muller, Elmi; Rando, Karina; Enoch, Mary Anne; Tamir, Noam; Healy, Pamela; Manser, Tanja; Briggs, Tim; Chaudhary, Abhideep; Humar, Abhinav; Jafarian, Ali; Soin, Arvinder S.; Eghtesad, Bijan; Miller, Charles; Cherqui, Daniel; Samuel, Didier; Bröering, Dieter C.; Pomfret, Elizabeth A.; Villamil, Federico; Durand, François; Berlakovich, Gabriela; McCaughan, Geoffrey W.; Auzinger, G.; Klintmalm, Göran B.; Belghiti, Jacques; Findlay, James Y.; Lai, Jennifer C.; Fung, John; Klinck, John R.; Roberts, John P.; Liu, Linda; Cattral, Mark S.; Ghobrial, R. Mark; Ramsay, Michael A. E.; Rela, Mohamed; Ascher, Nancy L.; Man, Nancy Kwan; Selzner, Nazia; Burra, P.; Friend, Peter J.; Busuttil, Ronald W.; Hwang, Shin; McCluskey, Stuart A.; Mas, Valeria R.; Vohra, Vijay; Vij, Vivek; Merritt, William T.; Tokat, Yaman; Kang, Yoogoo; Chan, Albert; Mazzola, Alessandra; Hessheimer, Amelia J.; Rammohan, Ashwin; Hogan, Brian; Vinaixa, Carmen; Nasralla, David; Victor, David W.; Martin, Eléonora De; Alconchel, Felipe; Roll, Garrett R.; Kabaçam, Gökhan; Sapisochín, Gonzalo; Campos‐Varela, Isabel; Liu, Jiang; Patel, Madhukar S.; Izzy, Manhal; Kalisvaart, Marit; Adams, Megan; Goldaracena, Nicholas; Tinguely, Pascale; Hernandez‐Alejandro, Roberto; Chadha, Ritu; Shaker, Tamer; Klair, Tarunjeet; Pan, Terry Ling Te; Tanaka, Tomohiro; Yoon, Uzung; Kirchner, Varvara A.; Hannon, Vivienne; Cheah, Yee Lee; Frola, C; Lurje, Georg; Fernández, T. Martínez; Badenoch, Adam; Mukhtar, Ahmed; Zanetto, Alberto; Montaño-Loza, Aldo J.; Chieh, Alfred Kow Wei; Shetty, Amol C.; DeWolf, Andre M.; Olmos, Andrea; Mrzljak, Anna; Blasi, Annabel; Berzigotti, Annalisa; Malik, Ashish; Rajakumar, Akila; Davidson, Brian R; Song, Gi-Won; Kotton, Camille Nelson; Imber, Charles; Kwon, Choon Hyuck David; Wray, Christopher; Ahn, Curie; Morkane, Clare; Krenn, Claus G.; Quintini, Cristiano; Maluf, Daniel G.; Mina, Daniel Santa; Sellers, Daniel; Balcı, Deniz; Patel, Dhupal; Rudow, Dianne LaPointe; Monbaliu, Diethard; Bezinover, Dmitri; Krzanicki, Dominik; Milliken, Don; Kim, Joo Young; Brombosz, Elizabeth W.; Blumberg, Emily A.; Weiss, Emmanuel; Wey, Emmanuel; Kaldas, Fady M.; Saliba, Faouzi; Pittau, Gabriella; Wagener, Gebhard; Song, Gi‐Won; Biancofiore, Gianni; Testa, Giuliano; Crespo, Gonzalo; Rodríguez, G.; Palli, Graciela Martínez; McKenna, Gregory B.; Petrowsky, Henrik; Egawa, Hiroto; Montasser, Iman Fawzy; Pirenne, Jacques; Eason, James D.; Guarrera, James V.; Pomposelli, James J.; Lerut, Jan; Emond, Jean C.; Boehly, Jennifer; Towey, Jennifer; Hillingsø, Jens; Jonge, Jeroen de; Potts, Jonathan R.; Caicedo, Juan C.; Heimbach, Julie K.; Emamaullee, Juliet; Bartoszko, Justyna; Wing, Ka; Kronish, Kate; Forkin, Katherine T.; Chok, Kenneth Siu Ho; Olthoff, Kim M.; Reyntjens, Koen; Lee, Kwang‐Woong; Suh, Kyung‐Suk; Denehy, Linda; Laan, Luc J. W. van der; McCormack, Lucas; Gorvin, Lucy; Ruffolo, Luis I.; Bhat, Mamatha; Ramírez, María Amalia Matamoros; Londoño, María-Carlota; Gitman, Marina; Levstik, Mark; Selzner, Markus; Santibañes, Martín de; Lindsay, Martine; Parotto, Matteo; Armstrong, Matthew; Kasahara, Mureo; Schofield, Nick; Rizkalla, Nicole; Akamatsu, Nobuhisa; Scatton, Olivier; Keskin, Onur; Imventarza, Oscar; Andacoglu, Oya; Muiesan, Paolo; Giorgio, Patricia; Northup, Patrick G.; Matins, Paulo; Abt, Peter L.; Newsome, Philip; Dutkowski, Philipp; Bhangui, Pooja; Bhangui, Prashant; Tandon, Puneeta; Brustia, Raffaele; Planinsic, Raymond M.; Brown, Robert S.; Porte, Robert J.; Barth, Rolf N.; Ciria, Rubén; Florman, Sander; Dharancy, Sébastien; Pai, Sher‐Lu; Yagi, Shusuke; Nadalin, Silvio; Chinnakotla, Srinath; Forbes, Stuart J.; Rahman, Suehana; Hong, Suk Kyun; Sun, Li-Ying; Orloff, Susan L.; Rubman, Susan; Eguchi, Susumu; Ikegami, Toru; Reichman, Trevor; Settmacher, Utz; Aluvihare, Varuna; Xia, Victor W.; YOON, Young-In; Soejima, Yuji; Genyk, Yuri; Jalal, Arif Hanafi Bin; Borakati, Aditya; Gustar, Adrian; Mohamed, Ahmed Abdou; Ramı́rez, Alejandro F.; Rothnie, Alex; Scott, Aneya; Sharma, Anika; Munro, Annalise; Mahay, Arun; Liew, Belle; Hidalgo, Camila; Crouch, Cara; Yan, Cheung Tsz; Tschuor, Christoph; Shaw, Conrad; Schizas, Dimitrios; Fritche, Dominic; Huda, Fabia Ferdousi; Wells, Gemma; Farrer, Giselle; Kwok, Hiu Tat; Kostakis, Ioannis D.; Mestre-Costa, Joao; Fan, Ka Hay; Fan, Ka Siu; Fraser, Kyra; Jeilani, Lelia; Pang, Li; Lenti, Lorenzo; Kathirvel, M; Zachiotis, Marinos; Vailas, Michail; Milan, Michele Mazza; Elnagar, Mohamed M.; Alradhawi, Mohammad; Dimitrokallis, Nikolaos; Machairas, Nikolaos; Morare, Nolitha; Yeung, Oscar W.H.; Khanal, Pragalva; Satish, Pranav; Ghani, Shahi; Makhdoom, Shahroo; Arulrajan, Sithhipratha; Bogan, Stephanie; Pericleous, Stephanos; Blakemore, Timon; Otti, Vanessa; Lam, Walter Yu Hang; Jackson, Whitney E.; Abdi, Zakee

doi:10.1016/s2468-1253(22)00268-0

Cited by 30 publications

(8 citation statements)

References 81 publications

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“…This becomes even more important as the average age of the organ recipients is increasing and with it, the number of comorbidities the patients have. Achieving the aim of improving pre-transplant fitness within a structured pre-habilitation program, tailored to this patient population as is already recommended by several societies, will be essential to maintain high post-transplant success rates ( 26 , 31 ). Crespo et al identified 4 assessment tools to detect patients suitable for Enhanced Recovery After Surgery (ERAS) protocols in the pre-transplantation period [Karnofsky performance status (KPS), LFI, abdominal muscle mass, cardiopulmonary exercise testing] ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Physical activity decreases in patients on the liver transplant waiting list and influences postoperative outcome—a prospective cohort study

Magyar,

Bühlmann,

Becchetti

et al. 2024

Hepatobiliary Surg Nutr

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Background Physical deconditioning affects patients suffering from end-stage liver disease (ESLD). Liver transplantation (LT) is the only curative option for ESLD. Growing evidence suggests that pre-habilitation is beneficial in reducing post-surgical morbidity and mortality. We investigated physical activity (PA) in patients awaiting LT in a country with long waiting times. Methods Prospective, single center, longitudinal study in Bern, Switzerland between June 2019 and February 2020 (halted due to SARS-CoV-2 pandemic), with follow-up data up to six months post-transplant. Patients were instructed to use a wrist tracker (FitBit) to monitor PA, which was assessed using mixed-effects generalized linear models. The study was approved by the local ethics committee (BASEC ID 2019-00606). Results Thirty-five patients were included [71% male, median 59 years, body mass index (BMI) 28 kg/m 2 , lab Model End-Stage Liver Disease (MELD) 11], 17 (49%) pre-frail and 5 (14%) frail according to the Liver Frailty Index (LFI). Twenty-eight patients underwent transplantation with 0 ninety-day mortality and 15 (53.6%) composite adverse clinical outcome. Median daily steps were 4,661 [interquartile range (IQR), 1,685–8,609] and weekly moderate PA (MPA) was 41 min (IQR, 0–127 min). Longitudinal analysis showed that female patients and patients on nutritional support had an increase in MPA between weeks 20 and 40. A significant decrease was seen in MPA after week 40, whilst no significant association was seen with age, Child-Pugh Score, LFI or quality of life at time of inclusion. MPA was significantly associated with the occurrence of the composite clinical endpoint after week 30 of waiting time (odds ratio 0.882, P=0.026). World Health Organization (WHO)-recommended MPA was significantly associated with less adverse composite clinical outcomes (P<0.001). Conclusions In patients listed for LT, MPA decreased over time, showing a significant association with adverse outcome, specifically after week 30 on the waiting list. Our data support the implementation of routine pre-habilitation in patients awaiting LT.

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Section: Discussionmentioning

confidence: 99%

“…Independent of surgery, the World Health Organization (WHO) recommends 150–300 min of moderate physical activity (MPA) weekly ( 25 ). Whilst pre-habilitation before LT is strongly recommended in the 2022 International Liver Transplantation Society consensus guidelines, the quality of evidence remains very low ( 26 ).…”

Section: Introductionmentioning

confidence: 99%

Physical activity decreases in patients on the liver transplant waiting list and influences postoperative outcome—a prospective cohort study

Magyar,

Bühlmann,

Becchetti

et al. 2024

Hepatobiliary Surg Nutr

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“…To increase the survival rates of LT candidates, preoperative risk assessment for risk is essential. Most patients with ESLD who undergo LT are physically deconditioned, with low functional capacity, malnutrition, sarcopenia, and frailty[ 10 , 15 ]. Sarcopenia is a common symptom of ESLD that strongly affects adverse outcomes and mortality in this population[ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and clinical impact of sarcopenia in liver transplant recipients: A meta-analysis

Jiang,

Wu,

Duan

et al. 2024

World J Gastroenterol

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BACKGROUND The prevalence of sarcopenia in patients undergoing liver transplantation (LT) remains to be determined partly because of different diagnostic criteria. Sarcopenia has recently been recognized as a new prognostic factor for predicting outcomes in LT candidates. AIM To estimate the prevalence of sarcopenia and evaluate its clinical effect on LT candidates. METHODS This systematic search was conducted in PubMed, Web of Science, Embase, and Cochrane Library for original English-language articles that investigated the prevalence and influence of sarcopenia in patients undergoing LT from database inception to November 30, 2022. Cohort studies of the definition of sarcopenia that estimate sarcopenia prevalence and evaluate its effect on clinical outcomes and the risk of mortality were included. RESULTS Twenty-five studies involving 7760 patients undergoing LT were included. The pooled prevalence of sarcopenia in patients undergoing LT was 40.7% [95% confidence intervals (95%CI): 32.1–49.6]. The 1-, 3-, and 5-year cumulative probabilities of post-LT survival in patients with preoperative sarcopenia were all lower than those without sarcopenia (P < 0.05). Sarcopenia was associated with an increased risk of post-LT mortality in patients undergoing LT (adjusted hazard ratio: 1.58; 95%CI: 1.21–2.07). Patients with preoperative sarcopenia had a longer intensive care unit stay, a high risk ratio of sepsis, and serious post-LT complications than those without sarcopenia. CONCLUSION Sarcopenia is prevalent in a substantial proportion of patients undergoing LT and is strongly and independently associated with higher a risk of mortality risk.

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“…Furthermore, we identified eight hub genes (VSNL1, TH, PCP4, IGDCC3, RAD51AP2, MUC2, BUB1, and BUB1B) that promoted tumor progression and were associated with prognosis according to the Kaplan–Meier and ROC curve analyses. TH, IGDCC3, RAD51AP2, and MUC2 are genes that were identified by WGCNA and are related to the clinical prognosis and survival of cholangiocarcinoma, but they have already been reported [ 5 , 32 , 33 , 34 ]. Therefore, VSNL1, PCP4, BUB1, and BUB1B were chosen for further verification.…”

Section: Discussionmentioning

confidence: 99%

Characteristic Analysis of Featured Genes Associated with Cholangiocarcinoma Progression

et al. 2023

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The noninvasive diagnosis of cholangiocarcinoma (CCA) is insufficiently accurate. Therefore, the discovery of new prognostic markers is vital for the understanding of the CCA mechanism and related treatment. The information on CCA patients in The Cancer Genome Atlas database was used for weighted gene co-expression network analysis. Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were applied to analyze the modules of interest. By using receiver operating characteristic (ROC) analysis to analyze the Human Protein Atlas (HPA), the featured genes were subsequently verified. In addition, clinical samples and GSE119336 cohort data were also collected for the validation of these hub genes. Using WGCNA, we identified 61 hub genes that regulated the progression and prognosis of CCA. Eight hub genes (VSNL1, TH, PCP4, IGDCC3, RAD51AP2, MUC2, BUB1, and BUB1B) were identified which exhibited significant interactions with the tumorigenic mechanism and prognosis of CCA. In addition, GO and KEGG clarified that the blue and magenta modules were involved with chromosome segregation, mitotic and oocyte meiosis, the cell cycle, and sister chromatid segregation. Four hub genes (VSNL1, PCP4, BUB1, and BUB1B) were also verified as featured genes of progression and prognosis by the GSE119336 cohort data and five human tissue samples.

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Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference

Cited by 30 publications

References 81 publications

Physical activity decreases in patients on the liver transplant waiting list and influences postoperative outcome—a prospective cohort study

Physical activity decreases in patients on the liver transplant waiting list and influences postoperative outcome—a prospective cohort study

Prevalence and clinical impact of sarcopenia in liver transplant recipients: A meta-analysis

Characteristic Analysis of Featured Genes Associated with Cholangiocarcinoma Progression

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