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.