Zhang YY, Guo DX, Liu Y, Shang MY, Liu XY, Li JF. Comprehensive oral care protocol reduces oral complications in liver transplant recipients: A retrospective cohort study. World J Gastrointest Surg 2026; 18(6): 117925 [DOI: 10.4240/wjgs.117925]
Corresponding Author of This Article
Jia-Feng Li, Associate Chief Nurse, Department of Critical Care Medicine, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, No. 848 Dongxin Road, Gongshu District, Hangzhou 310022, Zhejiang Province, China. shulanicu123@163.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
research-article
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Zhang YY, Guo DX, Liu Y, Shang MY, Liu XY, Li JF. Comprehensive oral care protocol reduces oral complications in liver transplant recipients: A retrospective cohort study. World J Gastrointest Surg 2026; 18(6): 117925 [DOI: 10.4240/wjgs.117925]
Yuan-Yuan Zhang, College of Graduate School, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
Yuan-Yuan Zhang, Dong-Xian Guo, Ying Liu, Ming-Yi Shang, Xing-Yu Liu, Jia-Feng Li, Department of Critical Care Medicine, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, Hangzhou 310022, Zhejiang Province, China
Author contributions: Zhang YY, Guo DX, Liu Y, Shang MY, Liu XY, and Li JF drafted the manuscript; Zhang YY, Guo DX, Liu Y, and Shang MY participated in data processing and analysis; Zhang YY and Liu XY contributed to data analysis and interpretation; Zhang YY and Li JF conceived and designed the study; Li JF supervised the study. All authors seriously revised and approved the final manuscript.
Supported by Zhejiang Provincial Health and Wellness Industry Science and Technology Program, No. 2025HY0845.
Institutional review board statement: This retrospective cohort study was approved by the Research Ethics Committee of Shulan (Hangzhou) Hospital (Approval No. KY2025137).
Informed consent statement: Since this is a retrospective study containing no patient details, the signed informed consent is waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author.
Corresponding author: Jia-Feng Li, Associate Chief Nurse, Department of Critical Care Medicine, Shulan (Hangzhou) Hospital, Zhejiang Shuren University Shulan International Medical College, No. 848 Dongxin Road, Gongshu District, Hangzhou 310022, Zhejiang Province, China. shulanicu123@163.com
Received: December 18, 2025 Revised: January 25, 2026 Accepted: March 16, 2026 Published online: June 27, 2026 Processing time: 183 Days and 9.7 Hours
Abstract
BACKGROUND
Liver transplant recipients are at high risk for oral complications due to obligatory immunosuppression and critical illness.
AIM
To evaluate the impact of a comprehensive oral care protocol on oral health outcomes in postoperative nursing for liver transplant.
METHODS
We conducted a retrospective cohort study of 277 liver transplant recipients. Patients received either a comprehensive oral care intervention (n = 131), which included systematic risk assessment with the Oral Assessment Guide, hydration support, family engagement, and targeted therapies, or routine oral care (n = 146). The primary outcome was the incidence of oral complications.
RESULTS
The comprehensive care group experienced a significantly lower incidence of oral complications compared to the routine care group (5.34% vs 13.70%, P = 0.019). Complications emerged later (postoperative day 6 vs postoperative day 3) and accumulated more slowly in the intervention group. Furthermore, patients receiving comprehensive care maintained significantly better and more stable Oral Assessment Guide scores throughout their intensive care unit stay, with a median score of 7 from day 5 onwards, vs a median score of 9 in the routine care group (P < 0.05).
CONCLUSION
A nurse-led, comprehensive, protocol-driven oral care strategy significantly improves oral health outcomes by reducing and delaying complications in critically ill liver transplant recipients.
Core Tip: This retrospective cohort study of 277 liver transplant recipients shows that a nurse-led comprehensive oral care protocol - including Oral Assessment Guide-based risk stratification, hydration support, family engagement, and targeted therapies - significantly reduces the incidence of oral complications, delays the onset of oral complications, and maintains better oral health vs routine care.
