Interest of an Early Rehabilitation Program in Liver Transplant Surgery

The improvement of perioperative technics and the prevention of complications with immunosuppression allowed for the development with success of liver transplant. 1322 liver transplants occurred in 2016 in France to 806 in 2000. Centre Hospitalier Universitaire (CHU) of Rennes became a reference with 122 liver transplants in 2016 being the second liver transplant center in France.

Early rehabilitation concept is a multidisciplinary approach (surgical, anesthetic…) that aims to reduce the length of hospital stay and peri operative morbidity/mortality. These programs have first been developed in colorectal surgery before extending to complicated surgery like cephalic duodeno-pancreatectomy or hepatectomy. There are poor data in the literature on early rehabilitation program in liver transplant.

Inclusion criteria

• Patient older than 18 years old
• First liver transplant
• Liver transplant alone
• MELD (Model for End stage Liver Disease) score ≤ 15
• CHILD-PUGH score ≤ 8 if cirrhosis
• Body Mass Index < 30 kg/m2
• No history of transplant nor immunosuppression
• Absence of ascites nor hydrothorax drain
• Absence of treatment for diabetes
• Absence of renal insufficiency (glomerular filtration flow > 60 mL/min)
• Family help at home

Exclusion criteria

• Cold ischemia time > 8 hours
• Grafts from type III Maastricht
• Super urgent liver transplantation
• Perioperative blood transfusion > 4 packed red blood cells and/or 3 fresh frozen plasma
• Arterial anastomosis in splenic artery, in aorta or in coeliac artery
• Bilio-digestive anastomosis
• Persons deprived of liberty
• Pregnant or breastfeeding women