Echeverri Juan, Goldaracena Nicolas, Singh Akhil Kant, Sapisochin Gonzalo, Selzner Nazia, Cattral Mark S, Greig Paul D, Lilly Les, McGilvray Ian D, Levy Gary A, Ghanekar Anand, Renner Eberhard L, Grant David R, McCluskey Stuart A, Selzner Markus
Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, University Health Network, Toronto, Canada.
Department of Anesthesia, Toronto General Hospital, University Health Network, Toronto, Canada.
Transplant Direct. 2017 Sep 18;3(10):e213. doi: 10.1097/TXD.0000000000000730. eCollection 2017 Oct.
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.
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.
Fast-tracked versus ICU patients had a lower model for end-stage liver disease score (13 ± 4 vs 18 ± 7; < 0.0001), lower preoperative bilirubin levels (51 ± 50 μmol/L vs 119.4 ± 137.3 μmol/L; < 0.001), required fewer units of packed red blood cells (1.7 ± 1.78 vs 4.4 ± 4; < 0.0001), and less fresh-frozen plasma (2.7 ± 2 vs 5.8 ± 5; < 0.0001) during transplantation. Regarding postoperative outcomes, fast-tracked patients presented fewer bacterial infections within 30 days (6.5% [3] vs 29% [28]; = 0.002), no episodes of pneumonia (0% vs 11.3% [11]; = 0.02), and less biliary complications within the first year (6% [3] vs 26% [25]; = 0.001). Also, fast-tracked patients had a shorter posttransplant hospital stay (10.8 ± 5 vs 21.3 ± 29; = 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; = 0.001) and fresh-frozen plasma (2.7 ± 2 vs 5.8 ± 4.5; = 0.0001).
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.
我们评估了接受快速通道方案且未入住重症监护病房（ICU）的活体肝移植（LDLT）受者与接受移植后ICU护理的LDLT患者的患者特征。
在153例LDLT受者中，46例患者纳入我们的无ICU入住快速通道方案。对快速通道组患者和入住ICU组患者的供体和患者特征、围手术期特征以及术后结局和并发症进行比较。在亚组分析中，我们将快速通道组患者与入住ICU少于24小时的患者进行比较。
与入住ICU患者相比，快速通道组患者的终末期肝病模型评分更低（13±4对18±7；P<0.0001），术前胆红素水平更低（51±50μmol/L对119.4±137.3μmol/L；P<0.001），移植期间所需浓缩红细胞单位更少（1.7±1.78对4.4±4；P<0.0001），新鲜冰冻血浆更少（2.7±2对5.8±5；P<0.0001）。关于术后结局，快速通道组患者在30天内发生细菌感染的更少（6.5%[3例]对29%[28例]；P=0.002），无肺炎发作（0%对11.3%[11例]；P=0.02），且第一年发生胆道并发症的更少（6%[3例]对26%[25例]；P=0.001）。此外，快速通道组患者移植后住院时间更短（10.8±5对21.3±二十九；P=0.002）。在亚组分析中，与入住ICU少于24小时的患者相比快速通道组患者对浓缩红细胞（1.7±1.78对3.9±4；P=0.001）和新鲜冰冻血浆（2.7±2对5.8±4.5；P=0.0001）的需求量更低。
LDLT术后对选定患者采用快速通道是安全可行的。围手术期选择适合快速通道的LDLT受者的客观评分尚待确定。
