Supplementary Material for: Referral to liver transplant: a national survey from Portugal

Objectives
The referral of patients with cirrhosis to liver transplant (LT) is a multi-stage complex process. There is 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.

Conclusions
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.

### 研究目标
肝硬化患者转诊至肝移植（LT）是一个多阶段的复杂过程。目前缺乏关于该过程潜在挑战的数据。本研究旨在明确葡萄牙转诊临床医生所面临的挑战特征。

### 研究方法
这是一项来自葡萄牙里斯本Curry Cabral医院的横断面调查。调查于2024年8月至11月开放，为期90天。调查包含13个问题：其中5个问题用于参与者特征描述；8个问题用于肝移植转诊过程特征描述。

### 研究结果
共有56名临床医生回应了调查（回应率为46.7%）。他们的中位年龄（四分位距）为38.1岁（33.2-42.1岁）。培训水平方面：47人（83.9%）为专科医生级别，9人（16.1%）为研究员或实习生级别。回应者来自葡萄牙21家不同医院，其中8家（38.1%）提供三级医疗服务，2家（9.5%）为肝移植中心。在回应者中，以下方面存在异质性：肝移植转诊标准、肝脏相关预后评分、与肝移植中心的联系渠道、肝移植评估中的检查和就诊。他们中的许多人建议了以下改进措施：制定国家或区域转诊标准；加快与肝移植团队的沟通；加速获取肝移植评估中的检查或就诊机会；缩短首次预约肝移植团队的时间。

### 研究结论
葡萄牙临床医生明确了肝硬化患者转诊至肝移植过程中的若干挑战及改进方向。这些发现可为未来优化肝移植转诊流程的策略提供参考。