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Interpretation on the Consensus Recommendations of Enhanced Recovery for Liver Transplantation by the International Liver Transplantation Society
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摘要:
肝移植作为终末期肝病唯一有效的治疗手段，具有手术复杂、时间长、创伤大等特点，患者术后恢复面临感染、腹腔出血、排斥反应等诸多挑战，直接影响康复质量。加速术后康复(enhanced recovery after surgery,ERAS)作为一种新型围术期管理策略，可有效促进患者术后康复，目前已广泛应用于外科各领域，但目前我国肝移植领域尚缺乏全面、科学的ERAS通识方案。2022年12月，国际肝移植学会发布了首个《肝移植手术加速康复共识建议》，对接受死亡后器官捐献和活体器官捐献的肝移植受者、活体肝移植供者ERAS策略提出建议。本文对该共识要点进行详细解读，以期为我国肝移植患者围术期ERAS实践提供参考。
Abstract:Liver transplantation is the only effective treatment for end stage liver disease, which is characterized by complicated surgery, long surgery time, high trauma, etc, patients experience a variety of difficulties following surgery, including infection, abdominal bleeding and rejection, all of them directly affect the quality of rehabilitation. Enhanced Recovery After Surgery (ERAS), a novel perioperative management strategy, can effectively promote postoperative recovery of patients and has been extensively implemented in various fields of surgery. However, there are not any thorough and scientific universal ERAS protocols in the fields of liver transplantation in China. The first Consensus Recommendations of Enhanced Recovery for Liver Transplantation was issued by the International Liver Transplantation Society in December 2022, offering recommendations about ERAS strategies for liver transplantation recipients of receiving deceased and living organ donations, and for living donors of liver transplantation. This paper provides a detailed interpretation of its key points to offer a practical reference for domestic liver transplantation perioperative ERAS management.
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[1] 谢泽荣, 吴孟航, 任秋平, 等. 加速康复外科在肝移植中的作用及安全性[J]. 中国普外基础与临床杂志, 2020, 27: 1463-1468. [2] Brustia R, Monsel A, Conti F, et al. Enhanced Recovery in Liver Transplantation: A Feasibility Study [J]. World J Surg, 2019, 43: 230-241. [3] Katsanos G, Karakasi KE, Antoniadis N, et al. Enhanced recovery after surgery in liver transplantation: Challenges and feasibility [J]. World J Transplant, 2022, 12: 195-203. [4] 国家卫生计生委医管中心加速康复外科专家委员会. 中国肝移植围手术期加速康复管理专家共识(2018版) [J]. 中华普通外科杂志, 2018, 33: 268-272. [5] 中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021)(二) [J]. 协和医学杂志, 2021, 12: 632-640. [6] Pollok JM, Tinguely P, Berenguer M, et al. Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference [J]. Lancet Gastroenterol Hepatol, 2023, 8: 81-94. [7] Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables [J]. J Clin Epidemiol, 2011, 64: 383-394. [8] Jensen CB. Citizen Projects and Consensus-Building at the Danish Board of Technology:On Experiments in Democracy [J]. Acta Sociologica, 2005, 48: 221-235. [9] Lai JC, Tandon P, Bernal W, et al. Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases [J]. Hepatology, 2021, 74: 1611-1644. [10] Crespo G, Hessheimer AJ, Armstrong MJ, et al. Which preoperative assessment modalities best identify patients who are suitable for enhanced recovery after liver transplantation? A systematic review of the literature and expert panel recommendations [J]. Clin Transplant, 2022, 36: e14644. [11] 孙慧慧, 孙菊, 程莉洁, 等. 肝移植受者术前预康复的研究进展[J]. 护理学报, 2022, 29: 39-44. [12] Victor DW, 3rd, Zanetto A, Montano-Loza AJ, et al. The role of preoperative optimization of the nutritional status on the improvement of short-term outcomes after liver transplantation? A review of the literature and expert panel recommendations [J]. Clin Transplant, 2022, 36: e14647. [13] 中华医学会器官移植学分会围手术期管理学组. 肝移植围手术期营养支持专家共识(2021版) [J]. 中华器官移植杂志, 2021, 42: 385-391. [14] Bailey P, Vergis N, Allison M, et al. Psychosocial Evaluation of Candidates for Solid Organ Transplantation [J]. Transplantation, 2021, 105: e292-e302. [15] Liew B, Nasralla D, Iype S, et al. Liver transplant outcomes after ex vivo machine perfusion: a meta-analysis [J]. Br J Surg, 2021, 108: 1409-1416. [16] 易述红, 罗刚健, 易慧敏. 加速康复外科优化重型肝炎肝移植围手术期管理临床实践的专家共识[J]. 器官移植, 2017, 8: 251-259. [17] 张乐, 宋锴澄, 申乐. 加速康复外科理念推动下的多模式术后恶心呕吐管理策略：《第四版术后恶心呕吐管理指南》解读[J]. 协和医学杂志, 2021, 12: 490-495. [18] Shaker TM, Eason JD, Davidson BR, et al. Which cava anastomotic techniques are optimal regarding immediate and short-term outcomes after liver transplantation: A systematic review of the literature and expert panel recommendations [J]. Clin Transplant, 2022, 36: e14681. [19] Zhao JZ, Qiao LL, Du ZQ, et al. T-tube vs no T-tube for biliary tract reconstruction in adult orthotopic liver transplantation: An updated systematic review and meta-analysis [J]. World J Gastroenterol, 2021, 27: 1507-1523. [20] Goldaracena N, Bhangui P, Yoon YI, et al. Early removal of drains and lines after liver transplantation to reduce the length of hospital stay and enhance recovery - A systematic review of the literature and expert panel recommendations [J]. Clin Transplant, 2022, 36: e14687. [21] Yoon U, Bartoszko J, Bezinover D, et al. Intraoperative transfusion management, antifibrinolytic therapy, coagulation monitoring and the impact on short-term outcomes after liver transplantation-A systematic review of the literature and expert panel recommendations [J]. Clin Transplant, 2022, 36: e14637. [22] 张华鹏, 张嘉凯, 胡博文. 成人肝移植受者围术期凝血功能管理专家共识（ 2021版） [J]. 实用器官移植电子杂志, 2021, 9: 89-94. [23] Sun LY, Gitman M, Malik A, et al. Optimal management of perioperative analgesia regarding immediate and short-term outcomes after liver transplantation - A systematic review, meta-analysis and expert panel recommendations [J]. Clin Transplant, 2022, 36: e14640. [24] Kirchner VA, O'Farrell B, Imber C, et al. What is the optimal management of thromboprophylaxis after liver transplantation regarding prevention of bleeding, hepatic artery, or portal vein thrombosis? A systematic review of the literature and expert panel recommendations [J]. Clin Transplant, 2022, 36: e14629. [25] Campos-Varela I, Blumberg EA, Giorgio P, et al. What is the optimal antimicrobial prophylaxis to prevent postoperative infectious complications after liver transplantation? A systematic review of the literature and expert panel recommendations [J]. Clin Transplant, 2022, 36: e14631. [26] 易慧敏, 刘剑戎, 陆平兰, 等. 成人慢加急性肝衰竭肝移植围手术期管理专家共识[J]. 器官移植, 2020, 11: 533-542. [27] 卓金风, 吕海金, 易慧敏, 等. 肝移植术后加速康复护理的标准化操作流程[J]. 器官移植, 2020, 11: 121-125. [28] De Martin E, Londono MC, Emamaullee J, et al. The optimal immunosuppression management to prevent early rejection after liver transplantation: A systematic review of the literature and expert panel recommendations [J]. Clin Transplant, 2022, 36: e14614. [29] 张洪涛, 李霄, 陶开山. 中国肝移植免疫抑制治疗与排斥反应诊疗规范(2019版) [J]. 器官移植, 2021, 12: 8-14+28. [30] Liu J, Martins PN, Bhat M, et al. Biomarkers and predictive models of early allograft dysfunction in liver transplantation - A systematic review of the literature, meta-analysis, and expert panel recommendations [J]. Clin Transplant, 2022, 36: e14635. [31] 中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021)(一) [J]. 协和医学杂志, 2021, 12: 624-631. [32] 谢炎, 孙纪三, 郭庆军, 等. 2016年国际肝移植学会活体肝移植指南（摘译与解读） [J]. 实用器官移植电子杂志, 2020, 8: 425-429. [33] Izzy M, Brown RS, Eguchi S, et al. Optimizing pre-donation physiologic evaluation for enhanced recovery after living liver donation - Systematic review and multidisciplinary expert panel recommendations [J]. Clin Transplant, 2022, 36: e14680. [34] 吕国悦. 活体肝移植进展与展望（ 2000-2020） [J]. 中国实用外科杂志, 2020, 40: 163-166+170. [35] Cheah YL, Heimbach J, Kwon CHD, et al. Influence of surgical technique in donor hepatectomy on immediate and short-term living donor outcomes - A systematic review of the literature, meta-analysis, and expert panel recommendations [J]. Clin Transplant, 2022, 36: e14703. [36] 孔俊杰, 于光圣. 腹腔镜活体肝移植供肝切取术的临床应用进展[J]. 器官移植, 2022, 13: 736-741. [37] Ruffolo LI, Levstik M, Boehly J, et al. What is the optimal prophylaxis against postoperative deep vein thrombosis in the living donor to avoid complications and enhance recovery? - A systematic review of the literature and expert panel recommendations [J]. Clin Transplant, 2022, 36: e14688. [38] 陈栋. 中国肝移植受者选择与术前评估技术规范(2019版) [J]. 临床肝胆病杂志, 2020, 36: 40-43. [39] Patel MS, Egawa H, Kwon YK, et al. The role of graft to recipient weight ratio on enhanced recovery of the recipient after living donor liver transplantation - A systematic review of the literature and expert panel recommendations [J]. Clin Transplant, 2022, 36: e14630. [40] Rammohan A, Rela M, Kim DS, et al. Does modification of portal pressure and flow enhance recovery of the recipient after living donor liver transplantation? A systematic review of literature and expert panel recommendations [J]. Clin Transplant, 2022, 36: e14657. -
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