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).
Bibliographical noteFunding Information:
Claus Niemann, San Francisco, CA, USA, Joerg-Matthias Pollok, London, UK, Marina Berenguer, Valencia, Spain, Pascale Tinguely, London, UK, Jonathan Potts, London, UK, Carlo Flora, London, UK. Arun Mahay, London, UK, Zakee Abdi, London, UK. This manuscript was prepared for the ERAS4OLT.org Consensus Conference 2022, which is partially funded by the International Liver Transplant Society (ILTS).
© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
- discharge checklist
- discharge criteria
- length of stay
- liver function
PubMed: MeSH publication types
- Systematic Review
- Journal Article
- Research Support, Non-U.S. Gov't