When is the optimal time to discharge patients after liver transplantation with respect to short-term outcomes? A systematic review of the literature and expert panel recommendations

Abstract

Background: Several factors associated with prolonged hospital stay have been described. A recent study demonstrated that hospital length of stay (LOS) is directly associated with an increased cost for liver transplantation (LT) and may be associated with greater mortality; however, the factors associated with post-LT mortality are also related to a prolonged hospital stay, that is, those factors are confounders. Thus, the actual impact of the length of post-LT hospital stay on both short-term and long-term patient and graft survival remains uncertain. Objectives: To identify the optimal time to discharge patients after LT with respect to short-term outcomes; readmission rate, 30–90-mortality and morbidity. Methods: Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Initial search keywords for screening were as follows; ((discharge AND (time OR “time point” OR “time-point”)) OR “length of hospital stay” OR “length of stay”) AND ((liver OR hepatic) AND (transplant OR transplantation)). PROSPERO ID: CRD42021245598. Results: The strength of recommendation was rated as Weak, and we did not identify the direction of recommendations regarding the optimal timing after LT concerning short-term outcomes, including “Readmission rate,” six studies on 30- and/or 90-day mortality, and five studies on “30- and/or 90-day morbidity rate.”. Conclusions: Evidence is scarce to judge the optimal timing to discharge patients after LT with respect to short-term outcomes. In centers with robust outpatient follow-up, discharge can occur safely as early as post-transplant 6–8 days (Quality of Evidence [QOE]; Low | Grade of Recommendation; Weak).