Adult liver transplant anesthesiology practice patterns and resource utilization in the United States: Survey results from the society for the advancement of transplant anesthesia

Abstract

Introduction: Liver transplant anesthesiology is an evolving and expanding subspecialty, and programs have, in the past, exhibited significant variations of practice at transplant centers across the United States. In order to explore current practice patterns, the Quality & Standards Committee from the Society for the Advancement of Transplant Anesthesia (SATA) undertook a survey of liver transplant anesthesiology program directors. Methods: Program directors were invited to participate in an online questionnaire. A total of 110 program directors were identified from the 2018 Scientific Registry of Transplant Recipients (SRTR) database. Replies were received from 65 programs (response rate of 59%). Results:Our results indicate an increase in transplant anesthesia fellowship training and advanced training in transesophageal echocardiography (TEE). We also find that the use of intraoperative TEE and viscoelastic testing is more common. However, there has been a reduction in the use of veno-venous bypass, routine placement of pulmonary artery catheters and the intraoperative use of anti-fibrinolytics when compared to prior surveys. Conclusion:The results show considerable heterogeneity in practice patterns across the country that continues to evolve. However, there appears to be a movement towards the adoption of specific structural and clinical practices.

Perioperative management of adult living donor liver transplantation: Part 1 – recipients

“…While studies have shown the benefits of VET in reducing transfusion requirements, 96 data on its impact on long‐term outcomes in LT is limited. A recent survey by SATA reported increased use of prophylactic anticoagulants during the perioperative period of LT, and VETs would likely prove helpful in managing therapeutic anticoagulation 97 …”

International Liver Transplantation Society/Society for Advancement of Transplant Anesthesia Consensus Statement on Essential Attributes of a Liver Transplant Anesthesiologist

“…Anesthesia for LT is offered at many centers as a required rotation for anesthesiology residents but not consistently. The majority of programs surveyed in the United States required postresidency training for LT. 3,5 Furthermore, some centers offer formal fellowships in anesthesia for LT. SATA has published an outline of the required competencies in terms of milestones that an LT anesthesia fellow would need to achieve in a scaffolded manner. 6 These competencies were modeled after the Accreditation Council for Graduate Medical Education Milestones Project for Cardiovascular Anesthesiology.…”

Multicenter evaluation of the Quantra with the QStat Cartridge in adult patients undergoing liver transplantation

“…These whole-blood assays demonstrate the multifactorial derangement in hemostasis that can lead to excessive bleeding and/or thrombotic complications perioperatively more closely than plasma-based standard laboratory tests. In a recent survey, the Quality & Standard Committee from the Society for the Advancement of Transplant Anesthesia (SATA) reported 95% of responding liver transplantation centers use VET for transfusion guidance during liver transplant surgery 7 . The use of VET devices in liver transplantation has been associated with a reduction in intraoperative bleeding and blood product utilization when adopted in conjunction with a goal-directed treatment algorithm 8–13 .…”