Perioperative clinical practice in liver transplantation: a Canadian survey
Liver transplantation is the only treatment allowing survival of patients with end-stage liver disease. The liver is the second most transplanted organ in the world. Although post-operative mortality has declined over the past two decades, this high-risk surgery is still associated with numerous post-operative complications and approximately 10% mortality at 1 year. Innovative approaches must be developed in order to improve the postoperative outcomes of these patients. This research project will improve the care of liver transplant recipients by improving our understanding of the factors associated with postoperative complications, the perceived surgical risks of these patients, and the persistant clinical balance in the interventions performed in these patients. It will also allow the development of effective innovative interventions demonstrated by high quality data.
The specific objectives of the current study are to quantify the variability of practice between Canadian centers with regard to perioperative hemodynamic management of liver transplantation, to identify the characteristics of this management and those of patients which may affect the perception of their perioperative risk by clinicians as well as the selection of transplant candidates.
We will launch a pan-Canadian survey of anesthesiologists and transplant surgeons to meet these objectives. This survey will be constructed in a standardized way (choice of topics, validation of the questionnaire and establishment of the sampling population). A panel made up of experts in hepatobiliary surgery, hepatology, anesthesiology and intensive care will generate the set of topics of interest and content items to be included in the questionnaire which will then be validated and reduced using a modified Delphi method. Perioperative interventions related to hemodynamic management during liver transplantation, surgical techniques used, factors influencing the decision to transplant a patient and patient characteristics that may affect clinicians' perception of risk will be the main themes. Closed and semi-open thematic questions based on scenarios will be included in an electronic questionnaire. A validating phase will be done with representatives of the sampling population in order to assess the clinical sensitivity, the apparent validity and reproducibility of the questionnaire. The results obtained will be reported descriptively and/or analyzed quantitatively in order to compare the interventions carried out differently between the centers (proportions with chi-squares and ordinal scales with Wilcoxon rank sum test). We will conduct both quantitative analyses of survey responses as well as a descriptive thematic qualitative analysis of answers to semi-open questions.
The results of this survey will help describe the Canadian practice in liver transplantation. They will provide essential data for the creation of the ELIPTO research program, an important program for the improvement of perioperative liver transplant care. These data will allow the development of a future high-quality clinical trial evaluating different perioperative interventions.