Efficacy and safety of enhanced recovery after surgery protocol on liver transplantation: A meta-analysis.

Background: Enhanced recovery after surgery (ERAS), a multidisciplinary and multimodal perioperative care protocol, has been widely used in several surgical fields. However, the effect of this care protocol on liver transplant recipients with end-stage liver disease remains unclear.

Aim: To compare the clinical outcomes of the ERAS protocol and standard care (SC) for liver transplant recipients with end-stage liver disease.

Methods: PubMed, Web of Science, Cochrane Library, and EMBASE databases were systematically searched to identify literature reporting the effects of the ERAS protocol on clinical outcomes in patients undergoing liver transplant recipients with end-stage liver disease. All articles published to January 1, 2025 were searched, followed by data extraction of the included literature and independent quality assessment. Then pooled mean difference (MD) and odds ratio (OR) with a 95% confidence interval (CI) were calculated by either a random-effects or fixed-effects model.

Results: Overall, eight relevant studies (including two randomized controlled trials, two prospective cohort studies, and four retrospective cohort studies) involving 1220 patients (704 patients in the ERAS group and 516 patients in the SC group). The primary outcomes evaluated included intensive care unit (ICU) stay duration, hospital length of stay, overall complication rates, mortality, and 30-day readmission rates. Our findings showed that ERAS protocols significantly reduced ICU stay duration (MD: -1.21 days, 95%CI: -2.08 to -0.34; = 0.006), hospital length of stay (MD: -4.91 days, 95%CI: -7.45 to -2.37; = 0.0002), overall complication rates (OR = 0.32, 95%CI: 0.22-0.46; < 0.0001), and mortality (OR = 0.57, 95%CI: 0.33-0.98; = 0.04). However, ERAS was associated with an increased 30-day readmission rate (OR = 3.20, 95%CI: 1.54-6.67; = 0.003).

Conclusion: The current meta-analysis indicated that ERAS protocols can significantly improve short-term clinical outcomes in liver transplant recipients, although the increased readmission rate requires further investigation. Future studies should aim to refine ERAS protocols and explore their long-term efficacy and underlying mechanisms.