Evolution of a Transplant Surgery Advanced Practice Provider Practice Model in the Care of High-Acuity Liver Transplant Recipients: A Single-Center Experience.

BACKGROUND: The role of advanced practice providers (APPs) in an academic transplant surgical acute care setting remains to be defined. We sought to evaluate the impact of a transplant surgeon-APP (TSAPP) practice model on patient access and outcomes in the care of critically ill patients with end-stage liver disease (ESLD) in an academic transplant center. METHODS: A retrospective analysis evaluated the effect of practice model evolution over an 11-year period on hospital access of patients with ESLD to an academic liver transplantation center and survival outcomes. We compared 3 practice models: era 1 (transplant surgeon-general surgery resident; January 2009 to Sept 2012): vs era 2 ( transition transplant surgeon-general surgery resident to TSAPP; October 2012 to December 2016): vs era 3 (TSAPP; January 2017 to December 2020). RESULTS: Patient access to hospitalization and inpatient service census increased significantly over time with TSAPP model (P < .01). At the time of liver transplant, the median Model for End-Stage Liver Disease scores for era 1 (25), era 2 (33), and era 3 (34), P < .01, and patient requirement for intensive care unit for era 1 (7.1%), era 2 (44.8%), and era 3 (56.4%), P < .01, have increased. The overall 1-year patient survival rates remained comparable across all eras: era 1 (93.88%), era 2 (93.11%), and era 3 (94.06%), P = .77 CONCLUSIONS: The APPs play an integral role in clinical transplantation practice. The integration of APPs into the transplant surgical workforce increased access of high-acuity patients with ESLD to the transplantation center. In addition, it provided excellent patient and graft survival outcomes after liver transplant.

Assessment of Patient Knowledge of the Role of Advanced Practice Providers in Transplantation Surgical Care: A Single-Center Prospective Study.

BACKGROUND: Advanced practice providers (APPs) are integral to the contemporary transplant surgeon-APP practice model. Patient understanding of APPs' role is vital for optimal patient care and experience. Data on patient knowledge of APPs' roles remain scarce. We sought to assess patient awareness of APPs in their transplantation surgical team. METHODS: We conducted a prospective study on 100 consecutive transplant candidates and recipients ≥18 years, hospitalized in the transplant surgeon-APP Transplantation Intensive Care Unit (primary service) from September 16, 2019 through June 10, 2021. All patients received a 5-question survey (Table 1). Group 1 (first 50 patients) did not receive any printed introductory materials (Figs 1 and 2) before completing the questionnaire, whereas group 2 (last 50 patients) completed the survey after receiving the materials. RESULTS: Although > 90% of patients were knowledgeable about physician assistants (PAs) and nurse practitioners (NPs), the term "advanced practice providers" was unfamiliar to patients in both groups (Table 1). The level of patient recognition and comfort with APPs in the transplant surgeon-APP care team were comparable for both groups. CONCLUSIONS: Our study showed that transplant candidates and recipients were knowledgeable and highly comfortable that PAs and NPs are members of their transplantation surgical team. However, the term advanced practice providers was unfamiliar to the patients. Our study suggested that patient education on provider terms used in current health care delivery is essential and may enhance the patient experience.

Post-Covid-19 Cholangiopathy-A New Indication for Liver Transplantation: A Case Report.

Liver injury is one of the nonpulmonary manifestations described in coronavirus disease 2019 (COVID-19). Post-COVID-19 cholangiopathy is a special entity of liver injury that has been suggested as a variant of secondary sclerosing cholangitis in critically ill patients (SSC-CIP). In the general population, the outcome of SSC-CIP has been reported to be poor without orthotopic liver transplantation (OLT). However, the role of OLT for post-COVID-19 cholangiopathy is unknown. We present a case report of a 47-year-old man who recovered from acute respiratory distress syndrome from COVID-19 and subsequently developed end-stage liver disease from post-COVID-19 cholangiopathy. The patient underwent OLT and is doing well with normal liver tests for 7 months. To our knowledge, this is the first case report of a patient who underwent successful liver transplantation for post-COVID-19 cholangiopathy.