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Textbook Outcome Following Liver Transplantation

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Abstract

Background

Textbook outcome (TBO) is a patient-oriented composite criterion achieved when all desired main health outcomes are realized. The aim was to assess the incidence and the independent factors associated with TBO following LT.

Methods

This bicentric study included all patients who underwent their first elective liver-only LT between 2011 and 2015. TBO occurred when all the following criteria were fulfilled: no mortality within 90 days, no major complications within 90 days, no reintervention within 90 days (liver graft biopsy, radiological, endoscopic or surgical interventions, or retransplantation), no prolonged intensive care unit stay, and no prolonged hospital stay. Univariable and multivariable analyses were performed to identify factors associated with TBO and to assess whether TBO is an independent factor associated with patient and graft survival.

Results

The study population included 530 patients. TBO occurred in 176/530 (33%) patients. Independent factors associated with TBO included the balance of risk score, the use of an intraoperative temporary portacaval shunt, and duration of the operation. TBO was identified as an independent factor associated with graft survival but not patient survival.

Conclusions

TBO might be implemented in the patient–doctor decision-making regarding whether to proceed with LT and in the reporting of patient-level hospital performance related to LT.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

Abbreviations

LT:

Liver transplantation

TBO:

Textbook outcome

MELD:

Model for End-Stage Liver Disease

DRI:

Donor risk index

BAR:

Balance of risk

ICU:

Intensive care unit

ERAS:

Enhanced recovery after surgery

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Funding

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Authors and Affiliations

  1. Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Hôpital Pitié Salpêtrière, Paris, France

    Chetana Lim

  2. Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Catalonia, Spain

    Laura Llado, Emilio Ramos, Josefina Lopez-Dominguez, Alba Cachero & Joan Fabregat

  3. Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, 12 Avenue Paul Vaillant Couturier, 94200, Villejuif, France

    Chady Salloum & Daniel Azoulay

Authors
  1. Chetana Lim
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  2. Laura Llado
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  3. Chady Salloum
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  4. Emilio Ramos
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  5. Josefina Lopez-Dominguez
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  6. Alba Cachero
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  8. Daniel Azoulay
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Contributions

DA and CL involved in study concept and design. CL, LL, CS, ER, JLD, AC, JF, and DA involved in acquisition of data and analysis and interpretation of data. DA and CL drafted the manuscript. CL, LL, CS, ER, JLD, AC, JF, and DA participated in critical revision of the manuscript for important intellectual content. CLIM, LL, CS, ER, JLD, AC, JF, and DA participated in final approval of the manuscript.

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Correspondence to Daniel Azoulay.

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Lim, C., Llado, L., Salloum, C. et al. Textbook Outcome Following Liver Transplantation. World J Surg 45, 3414–3423 (2021). https://doi.org/10.1007/s00268-021-06255-5

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