Fast Track of Adult-to-Adult Live Donor Liver Transplant Recipients: Avoiding ICU Admission Reduces Complications and Post Transplant Hospital Stay
Toronto General Hospital, Toronto, ON, Canada.
Meeting: 2015 American Transplant Congress
Abstract number: B160
Keywords: Living-related liver donors
Session Information
Session Name: Poster Session B: Liver: Living Donors
Session Type: Poster Session
Date: Sunday, May 3, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Objective: We investigated if fast track of adult-to-adult live donor liver transplant (LDLT) recipients is safe and provides benefits for the post transplant hospital stay.
Methods: Every LDLT from 2009-2013 performed at our institution was identified. Patients were classified as fast-tracked (no post transplant ICU admission) or ICU-requiring group. Fast tracking was defined as early extubation after LDLT in the operating room or in the post anesthesia care unit, followed by transfer to the observation ward without the need of ICU care. Fast track decision was based on disease severity, transfusion requirements and time to extubation after skin closure.
Results: A total of 152 patients were analyzed. Forty six patients (30.2%) were included in the fast-tracked group, and 106 (69.7%) in the ICU group. No significant differences were seen between donors for both groups and all patients received a right hemiliver (SV-VIII) as a graft. Fast-tracked vs ICU patients had lower medical model for end stage liver disease (MELD) scores (13±4 vs 19±8; p= 0.0001), lower red blood cells transfusion rates (mean 2±2 Units vs 4±4 Units; p=0.0001), and less fresh frozen plasma (FFP) transfusions (3±3 Units vs 6±5; p=0.0001). In contrast, other demographic characteristics such as age, gender, BMI, and end-stage liver disease etiology showed no differences. Operative time was shorter in fast-tracked patients compared to those going to the ICU (500±79 min vs 539±108 min; p=0.032), respectively. Time to extubation after skin closure was shorter in fast-tracked patients compared to ICU group (mean 2.1 hours ±3.3 vs 18±48; p=0.0001). Median hospital stay after LDLT was shorter in fast-tracked patients (11 (6-28) days vs 21 (2-161) days; p=0.0001). Major complications were less common in the fast-track vs ICU group (8.6% vs 27.3%; p=0.01) with pneumonias only occurring in the ICU group (0% vs 8%; p=0.05). In addition, fast-tracked patients had lower bile duct complications compared to those that went to the ICU (6.5% vs 21.6%, p=0.03).
Conclusions: Fast-track without post operative ICU admission can be performed safely in selected low risk recipients after LDLT. Avoiding ICU admission has the potential to shorten hospital stay and reduce postoperative pneumonias.
To cite this abstract in AMA style:
Echeverri J, Goldaracena N, Singh A, Sapisochin G, Selzner N, Cattral M, Greig P, Lilly L, McGilvray I, Levy G, Ghanekar A, Renner E, Grant D, McCluskey S, Selzner M. Fast Track of Adult-to-Adult Live Donor Liver Transplant Recipients: Avoiding ICU Admission Reduces Complications and Post Transplant Hospital Stay [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/fast-track-of-adult-to-adult-live-donor-liver-transplant-recipients-avoiding-icu-admission-reduces-complications-and-post-transplant-hospital-stay/. Accessed November 23, 2024.« Back to 2015 American Transplant Congress