Anesthesia for liver transplantation in US academic centers: Institutional structure and perioperative care

Abstract

Investigators at a single institution have shown that the organization of the anesthesia team influences patient outcomes after liver transplant surgery. Little is known about how liver transplant anesthesiologists are organized to deliver care throughout the United States. Therefore, we collected quantitative survey data from adult liver transplant programs in good standing with national governing agencies so that we could describe team structure and duties. Information was collected from 2 surveys in a series of quantitative surveys conducted by the Liver Transplant Anesthesia Consortium. All data related to duties, criteria for team membership, interactions/communication with the multidisciplinary team, and service availability were collected and summarized. Thirty-four of 119 registered transplant centers were excluded (21 pediatric centers and 13 centers not certified by national governing agencies). Private practice sites (26) were later excluded because of a poor response rate. There were minimal changes in the compositions of the programs between the 2 surveys. All academic programs had distinct liver transplant anesthesia teams. Most had set criteria for membership and protocols outlining the preoperative evaluation, attended selection committees, and were always available for transplant surgery. Fewer were involved in postoperative care or were available for patients needing subsequent surgery. Most trends were associated with the center volume. In conclusion, some of the variance in team structure and responsibilities is probably related to resources available at the site of practice. However, similarities in specific duties across all teams suggest some degree of self-initiated specialization.

Director of anesthesiology for liver transplantation: Existing practices and recommendations by the united network for organ sharing

“…This suggests a grass‐roots effort by academic departments of anesthesia to optimize the quality of care by using a leadership model. The findings concur with our previous study showing a self‐directed trend to subspecialization in the field of liver transplantation …”

“…LTrAC survey results have been published previously, and the methods of survey development, data collection, and analysis have been described . Institutional review board approval was granted by Vanderbilt University Medical Center.…”

“…The Membership and Professional Standards Committee of the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) has approved a new bylaw recommending that each transplant center appoint a director of liver transplant anesthesia . This change is in response to evidence that anesthesiologists significantly influence liver transplant recipient outcomes and resource utilization but do not have uniform liver transplant experience or education …”

Service Requirements of Liver Transplant Anesthesia Teams: Society for the Advancement of Transplant Anesthesia Recommendations

“…The importance of anesthesia coverage is highlighted by the fact that liver transplant surgery cannot proceed unless anesthesiologists are immediately available with adequate resources and knowledge to provide care. By 2012, most academic centers in the United States had LTATs, but team duties were influenced by the time and financial resources that each Department of Anesthesiology was willing to provide . This led to considerable differences across the United States regarding how the teams were organized, what their responsibilities were, and their availability to cover cases .…”

“…By 2012, most academic centers in the United States had LTATs, but team duties were influenced by the time and financial resources that each Department of Anesthesiology was willing to provide . This led to considerable differences across the United States regarding how the teams were organized, what their responsibilities were, and their availability to cover cases . For example, large‐volume centers (>100 cases/year) usually had more thorough coverage plans than smaller‐sized programs, and their members participated more frequently in multidisciplinary meetings …”