The role of preoperative optimization of the nutritional status on the improvement of short-term outcomes after liver transplantation? A review of the literature and expert panel recommendations

Epidemiology of surgical site infections post-cesarean section in Africa: a comprehensive systematic review and meta-analysis

BACKGROUND

Surgical site infections (SSIs) are among the most common postoperative complications following cesarean section, particularly in Africa. These infections pose maternal health risks, including prolonged hospitalization, increased healthcare costs, and mortality. This systematic review and meta-analysis aimed to evaluate the epidemiology, pooled prevalence, and risk factors for SSIs after cesarean section in Africa.

METHODS

A systematic search of PubMed/MEDLINE, Scopus, and Web of Science databases was conducted to identify studies published between January 2000 and December 2023. The review followed PRISMA 2020 guidelines, and 41 studies spanning 18 African countries met the inclusion criteria. Data on SSI prevalence and risk factors were extracted, and the quality of studies was assessed using the Newcastle-Ottawa Scale. A random-effects model was used to estimate pooled prevalence, with subgroup analysis, sensitivity analyses, and meta-regression exploring variations across study characteristics. Publication bias was assessed using funnel plots.

RESULTS

The pooled prevalence of SSIs after cesarean section was 11% (95% CI: 9-12.9%) with substantial heterogeneity (I2 = 97%, < 0.001). Regional variations were observed, with the highest prevalence in Tanzania (34.1%) and Uganda (15%), and the lowest in Tunisia (5%) and Egypt (5.3%). Temporal trends revealed a peak in prevalence (16%) during 2011-2015, declining to 9.8% by 2016-2020. Prolonged rupture of membranes (PROM) was the most frequently reported risk factor (OR: 4.45-13.9), followed by prolonged labor (> 24 h) (OR: 3.48-16.17) and chorioamnionitis (OR: 4.37-9.74). Potential publication bias indicated by asymmetrical funnel plots.

CONCLUSION

SSIs following cesarean section remain a burden in Africa, with wide regional variations and multiple preventable risk factors. The findings highlight the need for targeted interventions, including improved infection control practices, antenatal care, and timely management of obstetric complications.

Application progress of early nutrition intervention in patients with hepatocellular carcinoma after liver transplantation

Liver transplantation, as an effective therapy for patients with liver cancer, plays an important role in improving the quality of life of patients. However, the complexity and trauma of liver transplantation can easily lead to the occurrence of malnutrition in patients, and then increase the risk of postoperative complications, which has aroused widespread clinical attention. Reasonable nutritional support can not only maintain the stability of the body's internal environment, reduce the occurrence of complications, but also promote the recovery of liver and other organ functions. In recent years, with the in-depth understanding of nutritional metabolism after liver transplantation, the application of enteral nutrition and parenteral nutrition in nutritional support after liver transplantation has been increasingly extensive and achieved remarkable results. This paper discusses the effect of early postoperative nutritional intervention on patients with liver cancer and liver transplantation, and combined with its mechanism of action, can better understand the effectiveness of intervention, and provide reference for the development of scientific and reasonable nutritional support programs in clinical practice.

Bridging the critically ill patient with acute to chronic liver failure to liver transplantation

Liver transplantation (LT) has emerged as an effective therapy for severe forms of acute-on-chronic liver failure (ACLF), an entity characterized by the development of multiorgan failure and high short-term mortality. The aim of critical care management of ACLF patients is to rapidly treat precipitating events and aggressively support failing organs to ensure that patients may successfully undergo LT or, less frequently, recover. Malnutrition and sarcopenia are frequently present, adversely impacting the prognosis of these patients. Management of critical care patients with ACLF is complex and requires the participation of different specialties. Once the patient is stabilized, a rapid evaluation for salvage LT should be performed because the time window for LT is often narrow. The development of sepsis and prolonged organ support may preclude LT or diminish its chances of success. The current review describes strategies to bridge severe ACLF patients to LT, highlights the minimal evaluation required for listing and the currently suggested contraindications to proceed with LT, and addresses different aspects of management during the perioperative and early posttransplant period.

Consensus document from the Spanish Society for Liver Transplantation: Enhanced recovery after liver transplantation

The goal of the Spanish Society for Liver Transplantation (Sociedad Española de Trasplante Hepático) is to promote and create consensus documents about current topics in liver transplantation with a multidisciplinary approach. To this end, in November 2022, the 10th Consensus Document Meeting was held, with the participation of experts from the 26 authorized Spanish liver transplantation programs. This edition discusses enhanced recovery after liver transplantation, dividing needed actions into 3periods: preoperative, intraoperative and postoperative. The evaluated evidence and the consensus conclusions for each of these topics are described.

Consensus document from the Spanish Society for Liver Transplantation: enhanced recovery after liver transplantation

The goal of the Spanish Society for Liver Transplantation (La Sociedad Española de Trasplante Hepático) is to promote and create consensus documents about current topics in liver transplantation with a multidisciplinary approach. To this end, in November 2022, the 10th Consensus Document Meeting was held, with the participation of experts from the 26 authorized Spanish liver transplantation programs. This edition discusses Enhanced Recovery After Liver Transplantation, dividing needed actions into three periods: preoperative, intraoperative and postoperative. The evaluated evidence and the consensus conclusions for each of these topics are described.

Enhanced recovery after surgery for liver transplantation: a review of recent literature

PURPOSE OF REVIEW

This review was created to highlight important articles from the past year related to the evolving field of enhanced recovery after surgery (ERAS) in liver transplantation that are relevant to the transplant anesthesiologist.

RECENT FINDINGS

The International Liver Transplantation Society (ILTS) recently completed a landmark project, the ERAS4OLT.org project, which culminated in 80 recommendations for ERAS in liver transplantation. These recommendations encompass management for deceased donor recipients, living donor recipients and living donors. This review highlights selected articles relevant to the perioperative management of deceased donor liver transplant recipients.

SUMMARY

Though, there are now published internationally agreed upon recommendations for ERAS topics specific to liver transplantation, there is an obvious need for further investigation into this area to provide high quality evidence to support these recommendations. It is reasonable to utilize these recommendations in ERAS protocols for individual institutions; however, more evidence is needed in several areas to confirm the effects of these protocols on short-term outcomes.

Progress of new-onset diabetes after liver and kidney transplantation

Organ transplantation is currently the most effective treatment for end-stage organ failure. Post transplantation diabetes mellitus (PTDM) is a severe complication after organ transplantation that seriously affects the short-term and long-term survival of recipients. However, PTDM is often overlooked or poorly managed in its early stage. This article provides an overview of the incidence, and pathogenesis of and risk factors for PTDM, aiming to gain a deeper understanding of PTDM and improve the quality of life of recipients.

Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference

There is much controversy regarding enhanced recovery for recipients of liver transplants from deceased and living donors. The objectives of this Review were to summarise current knowledge on individual enhanced recovery elements on short-term outcomes, identify key components for comprehensive pathways, and create internationally accepted guidelines on enhanced recovery for liver-transplant recipients. The ERAS4OLT.org collaborative partnered by the International Liver Transplantation Society performed systematic literature reviews on the effect of 32 relevant enhanced perioperative recovery elements on short-term outcomes, and global specialists prepared expert statements on deceased and living donor liver transplantation. The Grading Recommendations, Assessment, Development and Evaluations approach was used for rating of quality of evidence and grading of recommendations. A virtual international consensus conference was held in January, 2022, in which results were presented, voted on by the audience, and discussed by an independent international jury of eight members, applying the Danish model of consensus. 273 liver transplantation specialists from 30 countries prepared expert statements on elements of enhanced recovery for liver transplantation based on the systematic literature reviews. The consensus conference yielded 80 final recommendations, covering aspects of enhanced recovery for preoperative assessment and optimisation, intraoperative surgical and anaesthetic conduct, and postoperative management for the recipients of liver transplants from both deceased and living donors, and for the living donor. The recommendations represent a comprehensive overview of the relevant elements and areas of enhanced recovery for liver transplantation. These internationally established guidelines could direct the development of enhanced recovery programmes worldwide, allowing adjustments according to local resources and practices.