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Perioperative clinical practice in liver transplantation: a cross-sectional survey

Pratique clinique périopératoire en transplantation hépatique : un sondage transversal

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Abstract

Purpose

The objective of this study was to describe some components of the perioperative practice in liver transplantation as reported by clinicians.

Methods

We conducted a cross-sectional clinical practice survey using an online instrument containing questions on selected themes related to the perioperative care of liver transplant recipients. We sent email invitations to Canadian anesthesiologists, Canadian surgeons, and French anesthesiologists specialized in liver transplantation. We used five-point Likert-type scales (from “never” to “always”) and numerical or categorical answers. Results are presented as medians or proportions.

Results

We obtained answers from 130 participants (estimated response rate of 71% in Canada and 26% in France). Respondents reported rarely using transesophageal echocardiography routinely but often using it for hemodynamic instability, often using an intraoperative goal-directed hemodynamic management strategy, and never using a phlebotomy (medians from ordinal scales). Fifty-nine percent of respondents reported using a restrictive fluid management strategy to manage hemodynamic instability during the dissection phase. Forty-two percent and 15% of respondents reported using viscoelastic tests to guide intraoperative and postoperative transfusions, respectively. Fifty-four percent of respondents reported not pre-emptively treating preoperative coagulations disturbances, and 91% reported treating them intraoperatively only when bleeding was significant. Most respondents (48–64%) did not have an opinion on the maximal graft ischemic times. Forty-seven percent of respondents reported that a piggyback technique was the preferred vena cava anastomosis approach.

Conclusion

Different interventions were reported to be used regarding most components of perioperative care in liver transplantation. Our results suggest that significant equipoise exists on the optimal perioperative management of this population.

Résumé

Objectif

L’objectif de cette étude était de décrire certaines composantes de la pratique périopératoire en transplantation hépatique telles que rapportées par les cliniciens.

Méthode

Nous avons mené un sondage transversal sur la pratique clinique à l’aide d’un instrument en ligne comportant des questions sur des thèmes sélectionnés liés aux soins périopératoires des receveurs de greffe du foie. Nous avons envoyé des invitations par courriel à des anesthésiologistes canadiens, des chirurgiens canadiens et des anesthésiologistes français spécialisés en transplantation hépatique. Nous avons utilisé des échelles de type Likert à cinq points (de « jamais » à « toujours ») et des réponses numériques ou catégorielles. Les résultats sont présentés sous forme de médianes ou de proportions.

Résultats

Nous avons obtenu des réponses de 130 participants (taux de réponse estimé à 71 % au Canada et à 26 % en France). Les répondants ont déclaré utiliser rarement l’échocardiographie transœsophagienne de routine, mais l’utiliser fréquemment pour l’instabilité hémodynamique, souvent en utilisant une stratégie de prise en charge hémodynamique peropératoire axée sur les objectifs, et jamais en utilisant une phlébotomie (médianes des échelles ordinales). Cinquante-neuf pour cent des répondants ont déclaré utiliser une stratégie restrictive de gestion liquidienne pour prendre en charge l’instabilité hémodynamique pendant la phase de dissection. Quarante-deux pour cent et 15 % des répondants ont déclaré utiliser des tests viscoélastiques pour guider les transfusions peropératoires et postopératoires, respectivement. Cinquante-quatre pour cent des répondants ont déclaré ne pas traiter préventivement les troubles préopératoires de la coagulation, et 91 % ont déclaré les traiter en peropératoire uniquement lorsque les saignements étaient importants. La plupart des répondants (48-64 %) n’avaient pas d’opinion sur les temps ischémiques maximaux du greffon. Quarante-sept pour cent des répondants ont déclaré qu’une technique de ‘piggyback’ (anastomose latéroterminale) était l’approche préférée pour l’anastomose de la veine cave.

Conclusion

Différentes interventions ont été signalées pour la plupart des composantes des soins périopératoires dans la transplantation hépatique. Nos résultats suggèrent qu’il existe une incertitude significative concernant la prise en charge périopératoire optimale de cette population.

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Author contributions

Helen Trottier and Michaël Chassé are senior authors. Francois M. Carrier participated in research design, obtaining funding, performing the research, data collection, data curation, data analysis, and writing the manuscript. Christian Vincelette, Helen Trottier, and Michaël Chassé participated in research design, performing the research, data analysis, and writing the manuscript. Éva Amzallag, Khaled Dajani, Jeanne-Marie Giard, Stanislas Kandelman, Constantine Karvellas, Timur Özelsel, and Ève Simoneau participated in performing the research, collecting data, and writing the manuscript. Adrienne Carr, Prosanto Chaudhury, Nelson Gonzalez-Valencia, Alexandre Joosten, Stuart A. McCluskey, and Jeieung Park participated in data collection and writing the manuscript. René Fugère participated in performing the research and writing the manuscript.

Acknowledgments

We would like to thank all trainees who participated in the validation process of the survey: Maxime Caron-Goudreau, Catherine Boudrias, Jihad Abou Jamous, Félix Thibeault, Julien Belliveau, Fatine Karkri, Sonia Hadj-Mimoune, Janie Misheva, Tristan Desrosiers, Olivia D’Eugenio, and Ahmed Amine Alaoui. We would also like to thank the Canadian Donation and Transplantation Research Program for their help through the patient-partner platform and M. Murray Wilson (MW), a patient-partner, who helped analyze the data.

Disclosures

The authors declare no competing interests.

Funding statement

This study was supported by the Fonds de développement du Département d’anesthésiologie et de médecine de la douleur de l’Université de Montréal. Trainees who participated in the validation process of the survey received financial compensation. Dr. Chassé and Dr. Carrier are recipients of a Career Award from the Fonds de la Recherche du Québec – Santé (FRQS). Christian Vincelette received doctoral scholarships from the FRQS and Canadian Institutes of Health Research.

Prior conference presentations

Part of this work was presented as an oral presentation on 22 September 2022 at the annual meeting of the Société Française d’Anesthésie-Réanimation (SFAR) in Paris, France.

Editorial responsibility

This submission was handled by Dr. Philip M. Jones, Deputy Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada

    François M. Carrier MD, MSc, PhD(c)

  2. Critical Care Division, Department of Medicine, Centre hospitalier de l’Université de Montréal, Montreal, Canada

    François M. Carrier MD, MSc, PhD(c) & Michaël Chassé MD, PhD

  3. Health Innovation and Evaluation Hub, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), 900, rue St-Denis, porte S03-434, Montreal, QC, H2X 0A9, Canada

    François M. Carrier MD, MSc, PhD(c), Éva Amzallag MSc & Michaël Chassé MD, PhD

  4. Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, QC, Canada

    François M. Carrier MD, MSc, PhD(c)

  5. School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada

    Christian Vincelette RN, MSc

  6. Department of Social and Preventive Medicine, École de santé publique de l’Université de Montréal, Montreal, QC, Canada

    Helen Trottier PhD

  7. Department of Anesthesiology, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada

    Adrienne Carr MD

  8. Department of Surgery, McGill University Health Centre, Montreal, QC, Canada

    Prosanto Chaudhury MD, MSc

  9. Department of Surgery, University Health Centre, University of Alberta, Edmonton, AB, Canada

    Khaled Dajani MD

  10. Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada

    René Fugère

  11. Department of Medicine, Liver Disease Division, Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada

    Jeanne-Marie Giard MD, MPH

  12. Department of Anesthesiology, London Health Sciences Centre, London, ON, Canada

    Nelson Gonzalez-Valencia MD, MSc

  13. Department of Anesthesiology, Paris Saclay University, Paul Brousse Hospital, Villejuif, France

    Alexandre Joosten MD, PhD

  14. Department of Anesthesiology, McGill University Health Centre, Montreal, QC, Canada

    Stanislas Kandelman MD, MSc

  15. Division of Gastroenterology (Liver Unit), Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada

    Constantine Karvellas MD, MSc

  16. Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada

    Stuart A. McCluskey MD, PhD

  17. Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada

    Stuart A. McCluskey MD, PhD

  18. Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB, Canada

    Timur Özelsel MD

  19. Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, Vancouver, BC, Canada

    Jeieung Park MD

  20. Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Colombia, Vancouver, BC, Canada

    Jeieung Park MD

  21. Hepatobiliary Division, Department of Surgery, Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada

    Ève Simoneau MD, PhD

  22. Department of Medicine, Université de Montréal, Montreal, QC, Canada

    Michaël Chassé MD, PhD

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  1. François M. Carrier MD, MSc, PhD(c)
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  17. Ève Simoneau MD, PhD
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  18. Michaël Chassé MD, PhD
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Corresponding author

Correspondence to François M. Carrier MD, MSc, PhD(c).

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Carrier, F.M., Vincelette, C., Trottier, H. et al. Perioperative clinical practice in liver transplantation: a cross-sectional survey. Can J Anesth/J Can Anesth 70, 1155–1166 (2023). https://doi.org/10.1007/s12630-023-02499-y

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