Zheng Ying-Jun, Pan Yi, Li Dong-Lun, Zhang Jin-Chang, Tao Ji-Lin, Li Peng-Cheng, Liu Xiang-Dong, An Chong-Gui, Luo Guo-Song
Department of Hepatobiliary Surgery, Sichuan Provincial People's Hospital East Sichuan Hospital, Dazhou First People's Hospital, Dazhou 635000, Sichuan Province, China.
Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany.
World J Gastrointest Surg. 2025 Jul 27;17(7):107085. doi: 10.4240/wjgs.v17.i7.107085.
Enhanced recovery after surgery (ERAS), a multidisciplinary and multimodal perioperative care protocol, has been widely used in several surgical fields. However, the effect of this care protocol on liver transplant recipients with end-stage liver disease remains unclear.
To compare the clinical outcomes of the ERAS protocol and standard care (SC) for liver transplant recipients with end-stage liver disease.
PubMed, Web of Science, Cochrane Library, and EMBASE databases were systematically searched to identify literature reporting the effects of the ERAS protocol on clinical outcomes in patients undergoing liver transplant recipients with end-stage liver disease. All articles published to January 1, 2025 were searched, followed by data extraction of the included literature and independent quality assessment. Then pooled mean difference (MD) and odds ratio (OR) with a 95% confidence interval (CI) were calculated by either a random-effects or fixed-effects model.
Overall, eight relevant studies (including two randomized controlled trials, two prospective cohort studies, and four retrospective cohort studies) involving 1220 patients (704 patients in the ERAS group and 516 patients in the SC group). The primary outcomes evaluated included intensive care unit (ICU) stay duration, hospital length of stay, overall complication rates, mortality, and 30-day readmission rates. Our findings showed that ERAS protocols significantly reduced ICU stay duration (MD: -1.21 days, 95%CI: -2.08 to -0.34; = 0.006), hospital length of stay (MD: -4.91 days, 95%CI: -7.45 to -2.37; = 0.0002), overall complication rates (OR = 0.32, 95%CI: 0.22-0.46; < 0.0001), and mortality (OR = 0.57, 95%CI: 0.33-0.98; = 0.04). However, ERAS was associated with an increased 30-day readmission rate (OR = 3.20, 95%CI: 1.54-6.67; = 0.003).
The current meta-analysis indicated that ERAS protocols can significantly improve short-term clinical outcomes in liver transplant recipients, although the increased readmission rate requires further investigation. Future studies should aim to refine ERAS protocols and explore their long-term efficacy and underlying mechanisms.
术后加速康复（ERAS）是一种多学科、多模式的围手术期护理方案，已在多个外科领域广泛应用。然而，该护理方案对终末期肝病肝移植受者的影响尚不清楚。
比较ERAS方案与标准护理（SC）对终末期肝病肝移植受者的临床结局。
系统检索PubMed、Web of Science、Cochrane图书馆和EMBASE数据库，以识别报告ERAS方案对终末期肝病肝移植受者临床结局影响的文献。检索截至2025年1月1日发表的所有文章，随后对纳入文献进行数据提取和独立质量评估。然后采用随机效应或固定效应模型计算合并平均差（MD）和比值比（OR）及其95%置信区间（CI）。
总体而言，八项相关研究（包括两项随机对照试验、两项前瞻性队列研究和四项回顾性队列研究）涉及1220例患者（ERAS组704例，SC组516例）。评估的主要结局包括重症监护病房（ICU）住院时间、住院时间、总体并发症发生率、死亡率和30天再入院率。我们的研究结果表明，ERAS方案显著缩短了ICU住院时间（MD：-1.21天，95%CI：-2.08至-0.34；P = 0.006）、住院时间（MD：-4.91天，95%CI：-7.45至-2.37；P = 0.0002）、总体并发症发生率（OR = 0.32，95%CI：0.22 - 0.46；P < 0.0001）和死亡率（OR = 0.57，95%CI：0.33 - 0.98；P = 0.04）。然而，ERAS与30天再入院率增加相关（OR = 3.20，95%CI：1.54 - 6.67；P = 0.0
