Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2025; 17(7): 107085
Published online Jul 27, 2025. doi: 10.4240/wjgs.v17.i7.107085
Efficacy and safety of enhanced recovery after surgery protocol on liver transplantation: A meta-analysis
Ying-Jun Zheng, Yi Pan, Dong-Lun Li, Jin-Chang Zhang, Ji-Lin Tao, Peng-Cheng Li, Xiang-Dong Liu, Chong-Gui An, Guo-Song Luo
Ying-Jun Zheng, Yi Pan, Jin-Chang Zhang, Ji-Lin Tao, Peng-Cheng Li, Chong-Gui An, Department of Hepatobiliary Surgery, Sichuan Provincial People's Hospital East Sichuan Hospital, Dazhou First People's Hospital, Dazhou 635000, Sichuan Province, China
Dong-Lun Li, Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Essen 45147, Germany
Xiang-Dong Liu, Department of Hepatobiliary Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan Province, China
Chong-Gui An, Department of Hepatobiliary Surgery, Sichuan Provincial People's Hospital, Chengdu 610000, Sichuan Province, China
Guo-Song Luo, Department of Center for Hepatobiliary Pancreatic Splenic Diseases, Zigong Fourth People's Hospital, Zigong 643000, Sichuan Province, China
Co-first authors: Ying-Jun Zheng and Yi Pan.
Author contributions: Zheng YJ, Pan Y and Luo GS were responsible for conceiving or designing the study; Zheng YJ, Pan Y, and An CG were responsible for the critical review and final approval; Zheng YJ and Li DL were responsible for drafting the work; Zheng YJ, Zhang JC, Tao JL, and Li PC were responsible for data collection and quality assessment; Zheng YJ, Liu XD, and Luo GS were responsible for analysis and interpretation of the data; All authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Song Luo, MD, Department of Center for Hepatobiliary Pancreatic Splenic Diseases, Zigong Fourth People's Hospital, No. 19 Tanmulin Street, Zigong 643000, Sichuan Province, China. guosongluozbb@163.com
Received: March 16, 2025
Revised: April 23, 2025
Accepted: May 23, 2025
Published online: July 27, 2025
Processing time: 130 Days and 23.3 Hours
Abstract
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; P = 0.006), hospital length of stay (MD: -4.91 days, 95%CI: -7.45 to -2.37; P = 0.0002), overall complication rates (OR = 0.32, 95%CI: 0.22–0.46; P < 0.0001), and mortality (OR = 0.57, 95%CI: 0.33–0.98; P = 0.04). However, ERAS was associated with an increased 30-day readmission rate (OR = 3.20, 95%CI: 1.54–6.67; P = 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.

Keywords: Liver transplantation; Enhanced recovery after surgery; Meta-analysis; Outcomes; End-stage liver disease

Core Tip: The enhanced recovery after surgery (ERAS) program represents an integrated, multidisciplinary approach to perioperative care, which has been widely adopted across various surgical specialties. However, the clinical outcomes of ERAS in liver transplant recipients remain inconclusive. The results of this meta-analysis will strengthen the existing evidence base in support of ERAS protocols in liver transplantation and guide future research and clinical practices.