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When Is It Safe for the Liver Donor to Be Discharged Home and Prevent Unnecessary Re-Hospitalizations? – a Systematic Review of the Literature and Expert Panel Recommendations Publisher Pubmed



Mazzola A1 ; Pittau G2 ; Hong SK3 ; Chinnakotla S4 ; Tautenhahn HM5 ; Maluf DG6 ; Settmacher U5 ; Spiro M8, 9 ; Raptis DA9, 10 ; Jafarian A7 ; Cherqui D2
Authors
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Authors Affiliations
  1. 1. Department of Hepatology and Gastroenterology, Liver transplant unit, Pite-Salpetriere Hospital, Paris, France
  2. 2. Liver transplant unit, Centre hepato biliaire Hopital Paul Brousse, Villejuif, France
  3. 3. Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
  4. 4. Department of Surgery, University of Minnesota Medical School, Minneapolis, United States
  5. 5. Department of General-Visceral-and Vascular Surgery, University Hospital, Jena, Germany
  6. 6. Program in Transplantation, University of Maryland Medical School, Baltimore, MD, United States
  7. 7. Division HPB Surgery and Liver Transplantation, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  8. 8. Department of Anesthesia and Intensive Care Medicine, Royal Free Hospital, London, United Kingdom
  9. 9. Division of Surgery & Interventional Science, University College London, London, United Kingdom
  10. 10. Clinical Service of HPB Surgery and Liver Transplantation, Royal Free Hospital, London, United Kingdom

Source: Clinical Transplantation Published:2022


Abstract

Background: Few data are available on discharge criteria after living liver donation (LLD). Objectives: To identify the features for fit for discharge checklist after LLD to prevent unnecessary re-hospitalizations and to provide international expert recommendations. Data sources: Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. Methods: Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. The critical outcomes included were complications rates and liver function (defined by elevated bilirubin and INR) (CRD42021260725). Results: Total 57/1710 studies were included in qualitative analysis and 28/57 on the final analysis. No randomized controlled trials were identified. The complications rate was reported in 20/28 studies and ranged from 7.8% to 71.2%. Post hepatectomy liver function was reported in 13 studies. The Quality of Evidence (QoE) was Low and Very-Low for complications rate and liver function test, respectively. Conclusions: Monitoring and prevention of donor complications should be crucial in decision making of discharge. Pain and diet control, removal of all drains and catheters, deep venous thrombosis prophylaxis, and use routine imaging (CT scan or liver ultrasound) before discharge should be included as fit for discharge checklist (QoE; Low | GRADE of recommendation; Strong). Transient Impaired liver function (defined by elevated bilirubin and INR), a prognostic marker of outcome after liver resection, usually occurs after donor right hepatectomy and should be monitored. Improving trends for bilirubin and INR value should be observed by day 5 post hepatectomy and be included in the fit for discharge checklist. (QoE; Very-Low | GRADE; Strong). © 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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