Shiffman Mitchell L, Rockey Don C
Hepatology Section and Liver Transplant Program, Virginia Commonwealth University Medical Center, Richmond, VA 23298, USA.
Liver Transpl. 2008 Aug;14(8):1092-9. doi: 10.1002/lt.21523.
Liver transplantation has evolved into a successful option for patients with end-stage liver disease. Transplant hepatologists are involved in the management of patients with end-stage liver disease both before and after liver transplantation. The goals of this study were to evaluate the roles that transplant hepatologists play at liver transplantation programs in the United States and the demand for and institutional support provided for these physicians. A web-based questionnaire was sent via e-mail to the medical directors of all 108 United Network for Organ Sharing-recognized liver transplant programs during the fall of 2006. Follow-up e-mails were sent and phone calls were made to those not completing the survey within 4 weeks. The survey was completed by 72 (67%) medical directors. The average number of liver transplants performed per center was 62, and a broad range of program sizes were represented. The number of transplant hepatologists increased in proportion to the number of transplants performed on an annual basis but lagged behind the number of surgeons and transplant coordinators. On average, 33 liver transplants were performed per year per transplant hepatologist. Transplant hepatologists were involved in all aspects of pretransplant and posttransplant care at all but 10% of these institutions; they provided virtually all pretransplant care at all of these programs and all long-term posttransplant care at 45% of these programs. Overall, 94% of liver transplant programs provided direct salary support and/or ancillary personnel for their transplant hepatologists. Despite this, over half of transplant hepatologists and 75% of those that received no direct salary support performed endoscopic procedures on a regular basis. Eighty-one percent of programs were recruiting additional transplant hepatologists. In conclusion, although the vast majority of transplant hepatologists receive institutional support, this support appears to be inadequate. The current shortage of transplant hepatologists is likely to increase if appropriate support mechanisms are not implemented.
肝移植已发展成为终末期肝病患者的一种成功治疗选择。移植肝病学家参与终末期肝病患者肝移植前后的管理。本研究的目的是评估移植肝病学家在美国肝移植项目中所起的作用以及对这些医生的需求和机构支持情况。2006年秋季，通过电子邮件向器官共享联合网络认可的所有108个肝移植项目的医学主任发送了一份基于网络的调查问卷。对于在4周内未完成调查的人员，发送了跟进电子邮件并致电。72名（67%）医学主任完成了调查。每个中心每年进行的肝移植平均数量为62例，涵盖了广泛的项目规模。移植肝病学家的数量与每年进行的移植手术数量成比例增加，但落后于外科医生和移植协调员的数量。平均而言，每位移植肝病学家每年进行33例肝移植手术。除了10%的机构外，移植肝病学家参与了移植前和移植后护理的各个方面；在所有这些项目中，他们几乎提供了所有的移植前护理，在45%的项目中提供了所有的移植后长期护理。总体而言，94%的肝移植项目为其移植肝病学家提供直接薪资支持和/或辅助人员。尽管如此，超过一半的移植肝病学家以及75%没有获得直接薪资支持的人员定期进行内镜检查。81%的项目正在招聘更多的移植肝病学家。总之，尽管绝大多数移植肝病学家获得了机构支持，但这种支持似乎并不充足。如果不实施适当的支持机制，目前移植肝病学家短缺的情况可能会加剧。
