Which preoperative assessment modalities best identify patients who are suitable for enhanced recovery after liver transplantation? A systematic review of the literature and expert panel recommendations

Crespo, Gonzalo; Hessheimer, Amelia J.; Armstrong, Matthew; Berzigotti, Annalisa; Monbaliu, Diethard; Spiro, Michael; Rapti, Dimitri Aristotle; Lai, Jennifer C.

doi:10.1111/ctr.14644

Cited by 14 publications

(5 citation statements)

References 37 publications

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“…In view of these results, the American Association for the Study of Liver Diseases guidance document suggests that all cirrhotic patients should be assessed for sarcopenia and frailty with standardized tools both at baseline and longitudinally[ 17 ]. These recommendations are consistent with the implementation of specific protocols such as “enhanced recovery after surgery” protocols to improve recovery after surgery, especially for LT candidates[ 49 ].…”

Section: Why Is It Important To Consider the Muscle In A Liver Transp...supporting

confidence: 57%

Improving the prognosis before and after liver transplantation: Is muscle a game changer?

Goffaux¹,

Delorme²,

Dahlqvist³

et al. 2022

World J Gastroenterol

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Liver transplantation (LT) is currently the only curative treatment option for selected patients with end stage liver disease or hepatocellular carcinoma. Improving waiting list-mortality, post-transplant morbidity and mortality and refining the selection of the patients remain our current central objectives. In this field, different concepts dealing with nutrition and the muscle such as sarcopenia, malnutrition, frailty or myosteatosis have emerged as possible game changers. For more than a decade, many prospective studies have demonstrated that sarcopenia and frailty are major predictive factors of mortality in the waiting list but also after LT. Malnutrition is also a well-known risk factor for morbidity and mor-tality. Muscle composition is a newer concept giving insight on muscle quality which has also been shown to be linked to poorer outcomes. Each of these terms has a precise definition as well as pathophysiological mechanisms. The bi-directional liver-muscle axis makes sense in this situation. Defining the best, easy to use in clinical practice tools to assess muscle quality, quantity, and function in this specific population and developing quality prospective studies to identify interventional strategies that could improve these parameters as well as evaluate the effect on mortality are among the important challenges of today.

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Section: Why Is It Important To Consider the Muscle In A Liver Transp...supporting

confidence: 57%

Improving the prognosis before and after liver transplantation: Is muscle a game changer?

Goffaux¹,

Delorme²,

Dahlqvist³

et al. 2022

World J Gastroenterol

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“…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 ). A recent systematic review on prehabilitation in patients awaiting LT did not detect an impact on adverse clinical outcomes including mortality due to sparse data ( 33 ).…”

Section: Discussionmentioning

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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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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“…The goal of anesthesia management for early extubation focuses around maintaining good postoperative analgesia with minimal respiratory depression. Several authors have recommended enhanced recovery pathways for liver transplantation utilizing various strategies to manage pain and aid with recovery in the perioperative period [43][44][45][46]. Most of the initial studies on early extubation utilized a balanced anesthetic approach, with volatile anesthetics supplemented with short acting narcotics such as fentanyl or remifentanil [17][18][19][20]23,35,47].…”

Section: Anesthetic Managementmentioning

confidence: 99%

The Practice of Fast-Track Liver Transplant Anesthesia

Aniskevich

Scott

Ladlie

2023

JCM

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Prior to the 1990s, prolonged postoperative intubation and admission to the intensive care unit was considered the standard of care following liver transplantation. Advocates of this practice speculated that this time allowed patients to recover from the stress of major surgery and allowed their clinicians to optimize the recipients’ hemodynamics. As evidence in the cardiac surgical literature on the feasibility of early extubation grew, clinicians began applying these principles to liver transplant recipients. Further, some centers also began challenging the dogma that patients need to be cared for in the intensive care unit following liver transplantation and instead transferred patients to the floor or stepdown units immediately following surgery, a technique known as “fast-track” liver transplantation. This article aims to provide a history of early extubation for liver transplant recipients and offer practical advice on how to select patients that may be able to bypass the intensive care unit and be recovered in a non-traditional manner.

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Which preoperative assessment modalities best identify patients who are suitable for enhanced recovery after liver transplantation? A systematic review of the literature and expert panel recommendations

Cited by 14 publications

References 37 publications

Improving the prognosis before and after liver transplantation: Is muscle a game changer?

Improving the prognosis before and after liver transplantation: Is muscle a game changer?

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

The Practice of Fast-Track Liver Transplant Anesthesia

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