Adult Liver Transplant Anesthesiology Practice in the Post-COVID-19 Era in the United States: Survey From the Society for the Advancement of Transplant Anesthesia.

BACKGROUND

Liver transplant (LT) anesthesiology has evolved alongside rising LT volumes in the United States. The formation of dedicated LT anesthesia teams (LTATs), formalization of director of LT anesthesia (DLTA), and standardization of LT anesthesia programs (LTAPs) have advanced the field. However, the current post-COVID-19 state of these initiatives remains poorly characterized.

METHODS

From May 1 to June 31, 2024, we conducted a national electronic survey of 101 DLTAs representing 151 active adult LT programs in the U.S., excluding pediatric programs and programs without identifiable DLTA contacts. The survey assessed LTAT structure, clinical practices, professional perceptions, and anticipated future challenges.

RESULTS

The response rate was 32.7% (33 of 101), predominantly from academic institutions (90.9%). Estimated number of LTATs averaged 6.6 members, with 38% fellowship-trained in transplant anesthesia, 27% in cardiothoracic anesthesia, and 23% in critical care. Overall 52% received institution-specific training. Forty two percent of LTAPs offered one-year LT anesthesiology fellowship. Most (82%) LTATs operated at 1:1 (including solo anesthesiologist in 15%) vs. 1:2 (7%) staffing ratios, involving residents (91% of cases), fellows (52%), and CRNAs (9%). Nearly all programs (94%) anticipated staffing changes, with 20 programs projecting 22 net hires. Approximately half of DLTAs (52%) considered their workforce adequate, while 36% reported a need for additional LT anesthesiologists. Overall, 76% of DLTAs were satisfied with their role, though increased workload (45%) and supply-demand mismatches (41%) were challenges.

CONCLUSION

Addressing workforce expansion and workload-related challenges may support LT anesthesia programs in meeting the demands of increasing national transplant volumes.