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. 2025 Apr 3:1-8.
doi: 10.1159/000545593. Online ahead of print.

Referral to Liver Transplant: A National Survey from Portugal

Filipe S Cardoso  1 , Mónica Sousa  1 , Luís Bagulho  1 , Milena Mendes  1 , Élia Mateus  1 , Helena Glória  1 , Jorge Lamelas  1 , Luís Bicho  1 , Raquel Mega  1 , João S Coelho  1 , Rui Perdigoto  1 , Hugo P Marques  1
Affiliations

Referral to Liver Transplant: A National Survey from Portugal

Filipe S Cardoso et al. GE Port J Gastroenterol. .

Abstract
in English, Portuguese

Introduction: The referral of patients with cirrhosis to liver transplant (LT) is a multi-stage, complex process. There is a lack of data on potential challenges to this process. We aimed to characterize challenges faced by Portuguese referring clinicians.

Methods: This was a cross-sectional survey from Curry Cabral Hospital, Lisbon, Portugal. The survey was open for 90 days, from August to November 2024. The survey included 13 questions: characterization of participants with 5 questions and characterization of the process of referral to LT with 8 questions.

Results: Overall, 56 clinicians responded to the survey (response rate of 46.7%). Their median (IQR) age was 38.1 (33.2-42.1) years. Their level of training was specialist grade for 47 (83.9%) and fellow or intern grade for 9 (16.1%) individuals. The responders were from 21 different hospitals in Portugal; 8 (38.1%) provided tertiary care and 2 (9.5%) were LT centers. Among responders, there was heterogeneity regarding the following topics: referring criteria to LT, liver-related prognostic scores, contact channels with the LT center, tests and visits part of the LT workup. Many of them suggested the following improvements to develop national or regional referral criteria, to expedite communication with the LT team, to accelerate access to the tests or visits part of the LT workup, and to shorten the time to the first appointment with the LT team.

Conclusion: Portuguese clinicians identified several challenges and improvements to the referral of patients with cirrhosis to LT. These findings may inform future strategies to streamline the referral to LT.

Introdução: A referenciação de doentes com cirrose para transplante hepático (TH) é um processo complexo em várias fases. Faltam dados sobre potenciais desafios a este processo. Pretendeu-se caracterizar os desafios enfrentados pelos médicos referenciadores portugueses.

Métodos: Tratou-se de um estudo transversal do Hospital Curry Cabral, Lisboa, Portugal. O inquérito esteve aberto durante 90 dias, de agosto a novembro de 2024. O inquérito contou com 13 questões: caracterização dos participantes com 5 questões; e caracterização do processo de referenciação para LT com 8 questões.

Resultados: No geral, 56 médicos responderam ao inquérito (taxa de resposta de 46.7%). A idade mediana (IQR) foi de 38.1 (33.2–42.1) anos. O nível de formação foi: especialista para 47 (83.9%) e interno para 9 (16.1%) indivíduos. Os inquiridos eram de 21 hospitais diferentes em Portugal, 8 (38.1%) prestavam cuidados terciários e 2 (9.5%) eram centros de TH. Entre os inquiridos, verificou-se heterogeneidade em relação aos seguintes temas: critérios de referenciação para TH; índices prognósticos relacionadas com o fígado; canais de contacto com o centro de LT; testes e visitas parte da avaliação para LT. Muitos deles sugeriram as seguintes melhorias: desenvolver critérios de referência nacionais ou regionais; agilizar a comunicação com a equipa de LT; acelerar o acesso aos testes e visitas parte da avaliação para TH; e encurtar o tempo para a primeira consulta com a equipa de LT.

Conclusão: Médicos portugueses identificaram vários desafios e melhorias na referenciação de doentes com cirrose para TH. Estes dados podem informar estratégias futuras para agilizar o encaminhamento para TH.

Keywords: Access; Barriers; Liver transplantation; Obstacles; Selection.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

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