*Purpose: Long-term use of immunosuppression is associated with increased risks of cardiovascular disease, chronic kidney disease, and cancer. We assessed practice patterns and provider adherence to long-term post-LT management guidelines (published by AASLD in 2012), and areas that lack clear guidance, through a survey tool sent to Hepatology providers across the country.

*Methods: An online anonymous survey was sent to hepatology providers at 51 tertiary care centers across 12 UNOS regions comprising 41 questions. Statistics were conducted using Kruskal-Wallis Test to compare Likert scores between groups. P value <0.05 was considered statistically significant.

*Results: 118 survey responses were received with an 86% survey completion rate across 10 UNOS regions. 72% of respondents were physicians, 28% advanced practice providers, and 90% overall from an academic setting. 31% of providers were in practice for <5 years, 23% for 5-9 years, 34% for 10-20 years, and 12% for >20 years. LT volume by institution varied, with 0-50 LT/year in 29%, 50-100 in 31%, and >100 in 40%. 93% of hepatology providers follow patients lifelong.

Screening for diabetes, hyperlipidemia, and chronic kidney disease was either not conducted or deferred to other services in 39%, 22%, 37% respectively. Annual fasting lipid screening post-LT varied according to LT volume/year ranging from 65% compliance (0-50 LT/year) to 32% (>100 LT/year) (p = 0.002).

57% providers routinely screen all patients for osteoporosis pre-LT with 69% following bone mineral density (BMD) post-LT. Adherence to pre-LT screening increased according to years in practice (p=0.003), and similarly correlated to appropriate post-LT surveillance intervals (p<0.01) across all pre-LT BMD results.

When surveying HCC post-LT, 99% follow either CT or MRI abdomen/pelvis, 57% utilize CT chest, and 70% of providers follow AFP. The frequency and duration of surveillance varied in both viable and non-viable HCC on explant, though the difference when compared against years of practice or LT volume/year was not statistically significant.

Routine colonoscopy screening in average-risk patients was started age 50 by 72% of providers, age 45 in 19%, and age 40 in 8%. Frequency of repeat screening colonoscopy was either 5 years (45%) or 10 years (51%). These differences were not statistically significant.

*Conclusions: We identified several differences in provider practices and adherence across the country in the long-term management of patients post-LT. In particular, opportunities were identified for improved screening adherence and secondary prevention of several metabolic complications. Defining the specific causes for variation in adherence and determining how to optimize outcomes is an important topic for further research.

« Back to 2020 American Transplant Congress