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

Brustia, Raffaele; Monsel, Antoine; Skurzak, Stefano; Schiffer, Eduardo; Carrier, François Martin; Patrono, Damiano; Kaba, Abdourahmane; Detry, Olivier; Malbouisson, Luíz Marcelo Sá; Andraus, Wellington; Vandenbroucke‐Menu, Franck; Biancofiore, Gianni; Kaido, Toshimi; Compagnon, Philippe; Üemoto, Shinji; Laiz, G. Rodríguez; Boer, M. de; Orloff, Susan L.; Melgar, P.; Buis, Carlijn I.; Zeillemaker‐Hoekstra, Miriam; Usher, Helen; Reyntjens, Koen; Baird, Emily; Demartines, Nicolas; Wigmore, Stephen J.; Scatton, Olivier

doi:10.1097/tp.0000000000003808

Cited by 79 publications

(57 citation statements)

References 83 publications

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“…J Hepatology 2019 13 ), ESPEN (Refers to Bischoff et al Clin Nutr 2020 14 ), AASLD (Refers to Lai et al Hepatology 2021 15 ), and NAWGoSiLT (Refers to Carey et al Hepatology 2019 16 ) clinical practice guidelines and modified according to the experience of the authors. For ERAS in LT we refer to Brustia et al Transplantation 2022 40 . *Suspected sarcopenia, myosteatosis or sarcopenic obesity.…”

Section: Interventional Strategiesmentioning

confidence: 99%

Body composition and the skeletal muscle compartment in liver transplantation: Turning challenges into opportunities

Reichelt

Pratschke

Engelmann

et al. 2022

American Journal of Transplantation

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Frailty, nutritional status, and body composition are increasingly under the spotlight of interest in various clinical scenarios including liver transplantation. To address the rapidly accumulating evidence in this field, recent European and North American practice guidelines have clearly underlined the clinical importance of nutritional status and body composition with adopting their assessment in patients with liver disease and in transplant candidates into their recommendations. While earlier reports, and therefore present guidelines, were focusing predominantly on quantitative alterations of the skeletal muscle mass (sarcopenia), recent studies have identified qualitative alterations such as intramuscular fat accumulation (myosteatosis) and sarcopenic obesity as emerging risk factors for poor clinical outcomes. In this review, the role of body composition in the context of liver transplantation will be discussed with a focus on the skeletal muscle compartment. A brief overview of current assessment modalities including their limitations, diagnostic challenges, prognostic significance, and pathophysiology are included. Possibilities to incorporate body composition parameters into clinical decision making are discussed. In addition, novel trends and remaining challenges in the therapeutic targeting of body composition and the skeletal muscle compartment are highlighted.

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Section: Interventional Strategiesmentioning

confidence: 99%

Body composition and the skeletal muscle compartment in liver transplantation: Turning challenges into opportunities

Reichelt

Pratschke

Engelmann

et al. 2022

American Journal of Transplantation

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“…However, malnutrition is a reversible risk factor, so early detection is important. The peri-operative period, referred to as pre-, intra-, and post-operative phases, is a critical and an important period in order to reduce complications and improve outcomes post-surgery (highlighted by the Enhanced Recovery After Surgery [ERAS] program) (22,23). In the context of LT, the pre-operative phase consists in prioritization and identification of patients at high risk and involves multiple biochemical analyses which require fasting (24,25).…”

Section: Discussionmentioning

confidence: 99%

Renal dysfunction independently predicts muscle mass loss in patients following liver transplantation

Nguyen

Mukaneza

Tremblay

et al. 2022

CanLivJ

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BACKGROUND: Liver transplantation (LT) is the only curative treatment for cirrhosis. However, the presence of complications can impact outcomes following LT. Sarcopenia, or muscle mass loss, is highly prevalent in patients with cirrhosis and is associated with longer hospitalization stays and a higher infection rate post-surgery. We aimed to identify patients at higher risk of early sarcopenia post-LT. METHODS: This retrospective study included 79 cirrhotic patients who underwent LT. Muscle mass was evaluated using the third lumbar spine vertebra skeletal muscle mass index (SMI) and sarcopenia was defined using established cut-off values. Computerized tomography (CT) scans performed within six-month peri-operative period (three months pre- and post-LT) were included in the study. Complications and comorbidities were collected and correlated to SMI post-LT and predictive models for SMI post-LT were constructed. RESULTS: The overall prevalence of sarcopenia was 46% and 62% before and after LT, respectively. Newly developed sarcopenia was found in 42% of patients. Post-LT sarcopenia was associated with longer hospital stays (54±37 vs 29±10 days, p = 0.002), higher number of infection (3±1 vs 1±2, p = 0.027), and greater number of complications (5±2 vs 3±2, p <0.001) compared to absence of sarcopenia. Multivariate analyses showed that the SMI post-LT was independently associated with pre-LT renal function markers, the glomerular filtration rate (GFR) and creatinine (Model 1, GFR: β = 0.33; 95% CI = 0.04–0.17; p = 0.003; Model 2, Creatinine: β = –0.29; 95% CI = –0.10 to –0.02; p = 0.009). CONCLUSIONS: The present study highlights the potential role of renal dysfunction in the development and persistence of sarcopenia after LT.

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“…The author concluded that early discharge from the hospital following LT is feasible, without a negative impact on patient or graft survival, nor did it increase short-term rehospitalization. A recent publication of Brustia et al [ 18 ] in Paris reinforced the basis for further developing ERAS in LT. Although it is a small-scale single-center observational study, the authors reported a 47% reduction of length of hospital stay with no safety issues in a small but well-designed protocol.…”

Section: Discussionmentioning

confidence: 99%

“…However, their study, with extremely short lengths of stay, was inherently flawed, as the authors pointed out, by a lack of a traditional control group; for this reason, their article was not included in our final selection. In 2021 Brustia et al [ 18 ] drafted the “Guidelines for Perioperative Care for Liver Transplantation: Enhanced Recovery After Surgery (ERAS) Society Recommendations,” after a systematic review by a wide international panel of experts and the application of the Delphi method. The authors of the manuscript recognized the lack of current strong evidence in ERAS in LT but laid a solid foundation and precious scaffold, which can serve as the basis for large studies in the definitive validation of ERAS in LT.…”

Section: Discussionmentioning

confidence: 99%

Enhanced recovery after surgery in liver transplantation: Challenges and feasibility

Katsanos¹,

Karakasi²,

Antoniadis³

et al. 2022

WJT

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BACKGROUND Enhanced recovery after surgery (ERAS) started a revolution that changed age-old surgical stereotypical practices regarding the overall management of the surgical patient. In the last decade, ERAS has gained significant acceptance in the community of general surgery, in addition to several other surgical specialties, as the evidence of its advantages continues to grow. One of the last remaining fields, given its significant complexity and intricate nature, is liver transplantation (LT). AIM To investigate the existing efforts at implementing ERAS in LT. METHODS We conducted a systematic review of the existing studies that evaluate ERAS in orthotopic LT, with a multimodal approach and focusing on measurable clinical primary endpoints, namely length of hospital stay. RESULTS All studies demonstrated a considerable decrease in length of hospital stay, with no readmission or negative impact of the ERAS protocol applied to the postoperative course. CONCLUSIONS ERAS is a well-validated multimodal approach for almost all types of surgical procedures, and its future in selected LT patients seems promising, as the preliminary results advocate for the safety and efficacy of ERAS in the field of LT.

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

Cited by 79 publications

References 83 publications

Body composition and the skeletal muscle compartment in liver transplantation: Turning challenges into opportunities

Body composition and the skeletal muscle compartment in liver transplantation: Turning challenges into opportunities

Renal dysfunction independently predicts muscle mass loss in patients following liver transplantation

Enhanced recovery after surgery in liver transplantation: Challenges and feasibility

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