Department of Digestive, Hepato-Biliary, and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France.
Department of Digestive, Hepato-Biliary, and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Centre de Recherche de Saint-Antoine, INSERM, UMRS-938, Paris, France.
Surgery. 2023 Oct;174(4):979-993. doi: 10.1016/j.surg.2023.06.041. Epub 2023 Aug 4.
Significant variations exist regarding the definition of difficult liver transplantation. The study goals were to investigate how liver transplant surgeons evaluate the surgical difficulty of liver transplantation and to use the identified factors to classify liver transplantation difficulty.
A Web-based online European survey was presented to liver transplant surgeons. The survey was divided into 3 parts: (1) participant demographics and practices; (2) various situations based on recipient, liver disease, tumor treatment, and technical factors; and (3) 8 real-life clinical vignettes with different levels of complexity. In part 3 of the survey, respondents were asked whether they would perform liver transplantation but were not aware that these patients eventually underwent liver transplantation.
A total of 143 invites were sent out, and 97 (67.8%) participants completed the survey. Most participants considered previous spontaneous bacterial peritonitis, previous supra-mesocolic surgery, hypertrophy of segment I, and obesity to be recipient factors for high-difficulty liver transplantation. Most participants considered liver transplantation to be challenging in patients with Budd-Chiari syndrome, Kasai surgery, polycystic liver disease, diffuse portal vein thrombosis, and a history of open hepatectomy. The proportion of participants indicating that liver transplantation was warranted varied across the 8 cases, from 69% to 100%. Our classification of the surgical difficulty of liver transplantation employed these recipient-related, surgical history-related, and liver disease-related variables and 3 difficulty groups were identified: low, intermediate, and high difficulty groups.
This survey provides an overview of the surgical difficulty of various situations in liver transplantation that could be useful for further benchmark and textbook outcome studies.
肝移植的定义存在显著差异。本研究旨在探讨肝移植外科医生如何评估肝移植的手术难度，并使用确定的因素对肝移植难度进行分类。
一项基于网络的欧洲调查呈现给肝移植外科医生。该调查分为 3 部分：（1）参与者的人口统计学和实践情况；（2）根据受者、肝脏疾病、肿瘤治疗和技术因素的各种情况；（3）8 个具有不同复杂程度的真实临床病例。在调查的第 3 部分，受访者被问及他们是否会进行肝移植，但不知道这些患者最终接受了肝移植。
共发出 143 份邀请，97 名（67.8%）参与者完成了调查。大多数参与者认为既往自发性细菌性腹膜炎、既往膈上手术、I 段肥大和肥胖是肝移植难度高的受者因素。大多数参与者认为在布加综合征、Kasai 手术、多囊肝、弥漫性门静脉血栓形成和开腹肝切除术史的患者中肝移植具有挑战性。8 个病例中，认为需要进行肝移植的参与者比例从 69%到 100%不等。我们采用这些与受者相关、与手术史相关和与肝脏疾病相关的变量对肝移植的手术难度进行分类，确定了 3 个难度组：低、中、高难度组。
本调查提供了肝移植各种情况下手术难度的概述，对于进一步的基准和教科书结局研究可能有用。
