When is the optimal time to discharge patients after liver transplantation with respect to short‐term outcomes? A systematic review of the literature and expert panel recommendations

BACKGROUND: Several factors associated with prolonged hospital stay have been described. A recent study demonstrated that hospital length of stay (LOS) is directly associated with an increased cost for liver transplantation (LT) and may be associated with greater mortality; however, the factors associated with post‐LT mortality are also related to a prolonged hospital stay, that is, those factors are confounders. Thus, the actual impact of the length of post‐LT hospital stay on both short‐term and long‐term patient and graft survival remains uncertain. OBJECTIVES: To identify the optimal time to discharge patients after LT with respect to short‐term outcomes; readmission rate, 30–90‐mortality and morbidity. METHODS: Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Initial search keywords for screening were as follows; ((discharge AND (time OR “time point” OR “time‐point”)) OR “length of hospital stay” OR “length of stay”) AND ((liver OR hepatic) AND (transplant OR transplantation)). PROSPERO ID: CRD42021245598 RESULTS: The strength of recommendation was rated as Weak, and we did not identify the direction of recommendations regarding the optimal timing after LT concerning short‐term outcomes, including “Readmission rate,” six studies on 30‐ and/or 90‐day mortality, and five studies on “30‐ and/or 90‐day morbidity rate.” CONCLUSIONS: Evidence is scarce to judge the optimal timing to discharge patients after LT with respect to short‐term outcomes. In centers with robust outpatient follow‐up, discharge can occur safely as early as post‐transplant 6–8 days (Quality of Evidence [QOE]; Low | Grade of Recommendation; Weak).