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Fast-tracking LT recipients improved overall survival, eliminated ICU costs

Liver transplant patients “fast-tracked” after surgery had greater overall survival compared with patients transferred to the ICU after transplantation, according to new study data.

C. Burcin Taner, MD, chair of transplant surgery at Mayo Clinic, in Jacksonville, Fla., and colleagues analyzed 1,296 liver transplant recipients between 2002 and 2010. The researchers studied the benefits of liver transplant patients being fast-tracked — sent to a clinic room after the post-anesthesia care unit (PACU) — compared with patients who went directly to the ICU.

C. Burcin Taner

“We have been fast-tracking patients after liver transplantation for more than a decade and our experience has demonstrated that a subset of patients can bypass the ICU after liver transplantation,” Taner said in a press release. “Avoiding the very expensive care in the ICU helps the patient as well as the health care system. For each patient thousands of dollars can be saves when bypassing the ICU entirely.”

Researchers said 54.3% of patients were successfully fast-tracked, and the remainder went to the ICU after a brief stay in the PACU. Analyses showed that overall patient survival (RR=0.75; 95% CI, 0.6-0.96) and graft survival (RR=0.78; 95% CI, 0.62-0.98) were better among patients who were successfully fast-tracked vs. the ICU. At 8 years after transplant, 74% of patients who were fast-tracked were alive compared with 65% sent to the ICU.

Multivariate analysis identified nine variables that determined whether a patient could stay in the PACU and bypass the ICU: male sex, younger age, low body weight, first transplant, shorter objective time, no hospitalizations before transplantation, a lower MELD score, fewer blood transfusions and limited use of medications to increase blood pressure.

To further validate the success of fast-tracking, researchers created a scoring system (AUC: 0.79; 95% CI, 0.765-0.816) to determine the likelihood of success a patient would have after being fast-tracked to the surgical ward among an independent group of 372 LT patients with similar AUC. The cohort validated the scoring system, the researchers wrote.

Beyond cost-savings, Taner said there are other benefits to avoiding the ICU.

“Keeping a patient on ventilation in the ICU increases the risk of infection and other complications can arise,” Taner said. “Many more tests, such as routine X-rays, are ordered in the ICU compared to post transplant care in the surgical ward.”

Disclosure: The researchers report no relevant financial disclosures.