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Introduction Enhanced recovery after surgery (ERAS) has been shown to facilitate discharge, decrease length of stay, improve outcomes and reduce costs. We used this concept to design a comprehensive fast-track pathway (OR-to-discharge) before starting our liver transplant activity and then applied this protocol prospectively to every patient undergoing liver transplantation at our institution, monitoring the results periodically. We now report our first six years results. Patients and methods Prospective cohort study of all the liver transplants performed at our institution for the first six years. Balanced general anesthesia, fluid restriction, thromboelastometry, inferior vena cava preservation and temporary portocaval shunt were strategies common to all cases. Standard immunosuppression administered included steroids, tacrolimus (delayed in the setting of renal impairment, with basiliximab induction added) and mycophenolate mofetil. Tacrolimus dosing was adjusted using a Bayesian estimation methodology. Oral intake and ambulation were started early. Results A total of 240 transplants were performed in 236 patients (191♂/45♀) over 74 months, mean age 56.3±9.6 years, raw MELD score 15.5±7.7. Predominant etiologies were alcohol (n = 136) and HCV (n = 82), with hepatocellular carcinoma present in 129 (54.7%). Nine patients received combined liver and kidney transplants. The mean operating time was 315±64 min with cold ischemia times of 279±88 min. Thirty-one patients (13.1%) were transfused in the OR (2.4±1.2 units of PRBC). Extubation was immediate (p=0.015) in the fast-track group. Patient survival was 86.8% at 1 year and 78.6% at five years. Conclusion Fast-Tracking of Liver Transplant patients is feasible and can be applied as the standard of care

Resumen La fiebre mediterranea familiar (FMF) es un sindrome hereditario de fiebre periodica caracterizada por ataques cortos de fiebre e inflamacion multisistemica (poliserositis y sinovitis, principalmente). El desarrollo de amiloidosis, sobre todo renal, es la principal complicacion. Los sintomas aparecen, en la mayoria de casos, antes de la segunda decada de vida. Se trata de una enfermedad hereditaria monogenica y el gen asociado se llama MEFV . El diagnostico genetico puede ser de gran ayuda, aunque existen aspectos que todavia no estan claros. En un porcentaje muy pequeno de pacientes, la enfermedad aparece de una forma atipica, es decir, mas tardia e iniciando con amiloidosis, sin existir antecedente de ataques previos inflamatorios o fiebres periodicas. Es el fenotipo II de la FMF. Presentamos el caso de un varon de 24 anos con amiloidosis renal que cumple estas caracteristicas, donde el estudio genetico resulto clave para el diagnostico.