Vincelette Christian, Mulongo Philémon, Giard Jeanne-Marie, Amzallag Éva, Carr Adrienne, Chaudhury Prosanto, Dajani Khaled, Fugère Réné, Gonzalez-Valencia Nelson, Joosten Alexandre, Kandelman Stanislas, Karvellas Constantine, McCluskey Stuart A, Özelsel Timur, Park Jeieung, Simoneau Ève, Trottier Helen, Chassé Michaël, Carrier François Martin
Health Innovation and Evaluation Hub, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Quebec, Canada.
Faculty of Medicine and Postdoctoral Studies, Université de Montréal, Montréal, Québec, Canada.
Can Liver J. 2024 Aug 28;7(3):352-367. doi: 10.3138/canlivj-2023-0037. eCollection 2024 Aug.
Liver transplant (LT) is the definitive treatment for end-stage liver disease. Limited resources and important post-operative implications for recipients compel judicious risk stratification and patient selection. However, little is known about the factors influencing physicians' assessment regarding patient selection for LT and risk evaluation.
We conducted a mixed-methods, cross-sectional survey involving Canadian hepatologists, anesthesiologists, LT surgeons, and French anesthesiologists. The survey contained quantitative questions and a vignette-based qualitative substudy about risk assessment and patient selection for LT. Descriptive statistics and qualitative content analyses were used.
We obtained answers from 129 physicians, and 63 participated in the qualitative substudy. We observed considerable variability in risk assessment prior to LT and identified many factors perceived to increase the risk of complications. Clinicians reported that the acceptable incidence of at least 1 severe post-operative complication for a LT program was 20% (95% CI: 20-30%). They identified the presence of any comorbidity as increasing the risk of different post-operative complications, especially acute kidney injury and cardiovascular complications. Frailty and functional disorders, severity of the liver disease, renal failure and cardiovascular comorbidities prior to LT emerged as important risk factors for post-operative morbidity. Most respondents were willing to pursue LT in patients with grade III acute-on-chronic liver failure but were less often willing to do so when faced with the uncertainty of a clinical example.
Clinicians had a heterogeneous appraisal of the post-operative risk of complications following LT, as well as factors considered in risk assessment.
肝移植（LT）是终末期肝病的确定性治疗方法。资源有限以及对受者术后的重要影响促使进行明智的风险分层和患者选择。然而，关于影响医生对LT患者选择评估和风险评估的因素知之甚少。
我们对加拿大肝病学家、麻醉学家、LT外科医生和法国麻醉学家进行了一项混合方法的横断面调查。该调查包含定量问题以及一项基于病例的关于LT风险评估和患者选择的定性子研究。采用描述性统计和定性内容分析。
我们获得了129名医生的答复，63人参与了定性子研究。我们观察到LT术前风险评估存在很大差异，并确定了许多被认为会增加并发症风险的因素。临床医生报告说，一个LT项目中至少发生1种严重术后并发症的可接受发生率为20%（95%CI：20 - 30%）。他们认为任何合并症的存在都会增加不同术后并发症的风险，尤其是急性肾损伤和心血管并发症。LT术前的虚弱和功能障碍、肝病严重程度、肾衰竭和心血管合并症是术后发病的重要危险因素。大多数受访者愿意为III级慢加急性肝衰竭患者进行LT，但面对临床实例的不确定性时，愿意这样做的情况较少。
临床医生对LT术后并发症的风险以及风险评估中考虑的因素评估存在异质性。
