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When is the optimal time to discharge patients after liver transplantation with respect to short‐term outcomes? A systematic review of the literature and expert panel recommendations
Journal article   Open access   Peer reviewed

When is the optimal time to discharge patients after liver transplantation with respect to short‐term outcomes? A systematic review of the literature and expert panel recommendations

Tomohiro Tanaka, Trevor W. Reichman, Andrea Olmos, Nobuhisa Akamatsu, Anna Mrzljak, Michael Spiro, Dimitri Aristotle Raptis, Gabriela Berlakovich and ERAS4OLT.org Working Group
Clinical transplantation, Vol.36(10), e14685
10/2022
DOI: 10.1111/ctr.14685
PMCID: PMC10078433
PMID: 35470472
Appears in  UI Libraries Support Open Access
url
https://doi.org/10.1111/ctr.14685View
Published (Version of record) Open Access CC BY-NC-ND V4.0

Abstract

Background Several factors associated with prolonged hospital stay have been described. A recent study demonstrated that hospital length of stay (LOS) is directly associated with an increased cost for liver transplantation (LT) and may be associated with greater mortality; however, the factors associated with post‐LT mortality are also related to a prolonged hospital stay, that is, those factors are confounders. Thus, the actual impact of the length of post‐LT hospital stay on both short‐term and long‐term patient and graft survival remains uncertain. Objectives To identify the optimal time to discharge patients after LT with respect to short‐term outcomes; readmission rate, 30–90‐mortality and morbidity. Methods Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Initial search keywords for screening were as follows; ((discharge AND (time OR “time point” OR “time‐point”)) OR “length of hospital stay” OR “length of stay”) AND ((liver OR hepatic) AND (transplant OR transplantation)). PROSPERO ID: CRD42021245598 Results The strength of recommendation was rated as Weak, and we did not identify the direction of recommendations regarding the optimal timing after LT concerning short‐term outcomes, including “Readmission rate,” six studies on 30‐ and/or 90‐day mortality, and five studies on “30‐ and/or 90‐day morbidity rate.” Conclusions Evidence is scarce to judge the optimal timing to discharge patients after LT with respect to short‐term outcomes. In centers with robust outpatient follow‐up, discharge can occur safely as early as post‐transplant 6–8 days (Quality of Evidence [QOE]; Low | Grade of Recommendation; Weak).
 Intensive Care discharge length of stay liver transplantation short‐term outcome UIOWA OA Agreement

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