Exploring Anesthesiology Management of Living Donor Liver Transplantation: Survey From the Society for the Advancement of Transplant Anesthesia and the Korean Society for Transplantation Anesthesiologists

Clin Transplant. 2024 Oct;38(10):e15428. doi: 10.1111/ctr.15428.

Abstract

Introduction: While living donor liver transplantation (LDLT) serves as the predominant method of adult liver transplant (LT) in the Republic of Korea (ROK), it represents a minority of LT in the United States (US). A survey was conducted to gain insight into these nations' anesthetic management.

Methods: An electronic questionnaire was distributed to directors of LT anesthesiology overseeing LDLT programs in both countries between May 2021 and October 2021.

Results: The response rate was 93.0% (100% [37/37] in the US and 80% [16/20] in the ROK). Both countries mainly adhered to deceased donor LT recipient management practices, including the frequency of routine pulmonary artery catheter use, transesophageal echocardiography, and point-of-care coagulation monitoring. Differences were observed in early extubation of recipients (US vs. ROK: 39.7% vs. 14.7% of all cases), participation in donor selection meetings (88.9% [32/36] vs. 6.3% [1/16], p < 0.0001), application of the Enhanced Recovery After Surgery donor protocol (69.4% [25/36] vs. 12.5% [2/16], p < 0.0001), and cell saver usage for donors (94.4% [34/36] vs. 18.8% [3/16], p < 0.0001). More ROK programs implemented simultaneous donor/recipient anesthesia supervision by a single anesthesiologist.

Conclusions: Several important differences were identified between the US and the ROK in adult LDLT anesthetic management.

Keywords: anesthesiology; liver transplantation; patient safety; survey.

MeSH terms

  • Anesthesia* / methods
  • Anesthesiologists*
  • Anesthesiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Liver Transplantation*
  • Living Donors* / supply & distribution
  • Male
  • Prognosis
  • Republic of Korea
  • Societies, Medical
  • Surveys and Questionnaires