Risk Evaluation and Recipient Selection in Adult Liver Transplantation: A Mixed-Methods Survey

Area of Science:

• Hepatology
• Transplant Surgery
• Anesthesiology

Background:

• Liver transplant (LT) is a critical treatment for end-stage liver disease.
• Careful patient selection and risk stratification are essential due to resource limitations and post-operative complexities.
• Factors influencing physician decisions in LT patient selection and risk assessment are not well understood.

Purpose of the Study:

• To investigate the factors influencing physicians' assessments in liver transplant (LT) patient selection.
• To evaluate the risk assessment and patient selection criteria used by clinicians involved in LT.

Main Methods:

• A mixed-methods, cross-sectional survey was conducted among Canadian and French hepatologists, anesthesiologists, and LT surgeons.
• The survey included quantitative questions and a qualitative substudy using clinical vignettes to assess risk.
• Data were analyzed using descriptive statistics and qualitative content analysis.

Main Results:

• 129 physicians responded, with 63 participating in the qualitative substudy.
• Significant variability was observed in pre-LT risk assessment, with numerous factors identified as increasing complication risk.
• Comorbidities, frailty, liver disease severity, renal failure, and cardiovascular issues were key risk factors for post-operative morbidity. An acceptable complication rate was reported as 20%.

Conclusions:

• Physicians exhibit heterogeneous approaches to appraising post-operative risks associated with liver transplantation.
• Variability exists in the factors considered during the risk assessment process for LT.