Application value of fast-track surgery on liver transplantation

  Objective   To explore the impact of fast-track surgery (FTS) on prognosis of liver transplant patients.

  Methods   Inclusion criterias: (1) primary disease was cirrhosis or primary liver cancer meeting Milan criteria; (2) surgical method was modified piggyback orthotopic liver transplantation (OLT); (3) no liver transplantation operation was performed before. Exclusion criterias: (1) age≤16 years old; (2) receiving OLT more than 1 time; (3) transcatheter hepatic arterial chemoembolization or radiofrequency ablation was performed before or during operation. From January 2011 to December 2013 in First Affiliated Hospital of Nanjing Medical University, 52 patients meeting the criteria above were enrolled into this prospective random single-blinded study(all operations were performed by same team). According to different peri-operative managements, they were divided into FTS group (n=21) and non-FTS (NFTS) group (n=31). Protocol of FTS included comprehensive pre-operative education, no bowel preparation, no usage of nasogastric tube pre-operation and surgical drainage post-operation, prevention of hypothermic during operation, smaller incision, early exercise and enhanced oral nutrition. Intra-and post-operative parameters were compared between 2 groups. Step-by-step Logistic regression was used to evaluate relationship between FTS and clinical parameters, in order to analyze the impact of FTS on the prognosis of liver transplantation.

  Results   Compared with NFTS group, operation time and anhepatic phase time decreased significantly in FTS group, as well as intra-operative bleeding and transfusion (all in P<0.05). Besides, intensive care unit(ICU) days and total length of stay in FTS group were shorter than those in NFTS group, which indicated a better prognosis of patients in FTS group(both in P<0.05). Logistic regression suggested that FTS management was a favorable factor of shortening ICU days (odds ratio: 0.301, 95% confidence interval: 0.184-0.494, P=0.000) and total length of stay (odds ratio: 0.148, 95% confidence interval: 0.085-0.257, P=0.000).

  Conclusions   Application of FTS in perioperative period can improve the prognosis of liver transplant patients.