Integrated care management model for liver transplantation: a narrative review and single-center implementation experience.

Abstract

<h4>Background and objective</h4>Liver transplantation (LT) is the most effective end-stage liver disease (ESLD) therapeutic intervention. However, in China, many liver transplant recipients lack a comprehensive management approach. This narrative review summarizes the current deficiencies in long-term post-transplant care and proposes a comprehensive model for Integrated Care Management (ICM) aimed at improving long-term outcomes after LT.<h4>Methods</h4>An extensive electronic literature search was performed using PubMed database to identify relevant articles. The search included prospective clinical trials, observational trials, case-control studies, systematic reviews with or without meta-analysis. Articles were limited to English and Chinese language publications. The following Medical Subject Headings (MeSH) terms and free-text keywords were combined with Boolean operators: ("liver transplantation" OR "liver transplant*" OR "orthotopic liver transplantation" OR "OLT") AND ("postoperative management" OR "whole-course management" OR "perioperative care" OR "long-term follow-up") AND ("immunosuppress*" OR "tacrolimus" OR "cyclosporine" OR "mycophenolate" OR "infection prophylaxis" OR "graft function" OR "rejection" OR "biliary stricture" OR "hepatic artery thrombosis" OR "renal dysfunction" OR "hepatitis B recurrence" OR "hepatitis C recurrence").<h4>Key content and findings</h4>Research has shown the global number of LT recipients continues to rise, affecting millions of individuals and placing a substantial burden on healthcare systems worldwide. Despite considerable progress over the past three decades in surgical techniques, perioperative care, and immunosuppressive therapy, long-term post-transplant management has received comparatively limited attention from both the public and policy-makers. This neglect has contributed to suboptimal long-term outcomes, including increased mortality and reduced quality of life among recipients.<h4>Conclusions</h4>A comprehensive model for ICM may be a new direction to improve the long-term outcomes after LT in the future.