Liver Transplant Anesthesia Practice Patterns in Canada, Australia, and New Zealand: Results From a Multi-National...

Liver transplantation is the only curative treatment for end-stage liver disease, yet perioperative management is complex and high-risk. Variations in anesthetic practices may influence outcomes, but benchmarks are scant. This study characterizes liver transplant anesthesia practices in Canada, Australia, and New Zealand to identify patterns and opportunities to establish a "standard of care."

An online questionnaire, adapted from the 2021 Society for the Advancement of Transplant Anesthesia survey, was distributed to the directors of liver transplant anesthesia at 18 adult and pediatric programs. The survey covered team structure, preoperative evaluation, intraoperative techniques, and postoperative management. Responses were stratified by annual transplant volume and analyzed using descriptive statistics and Fisher's exact test (p < 0.05).

Dedicated transplant anesthesia teams existed in 76% of centers, with 31% offering transplant fellowships. Standardized preoperative cardiac evaluation was reported by 82%, though only 31% used formal risk-stratification tools. More than half-59%-used transesophageal echocardiography and pulmonary artery catheters intraoperatively. Renal replacement therapy was applied in 76%, and viscoelastic testing in 82% of centers. Graft flushing on the back-table and in the surgical field occurred in 60% and 69% of programs, respectively; retrograde blood perfusion was used by 50%. Extubation at case-end was rare, while up to 25% of patients were extubated within 2-4 h. Postoperative intensive care unit admission was nearly universal.

These findings identified substantial practice variability, highlighting opportunities to develop consensus guidelines and targeted training to standardize perioperative care.