关于困难肝移植的定义存在显著差异。该研究旨在调查肝移植外科医生如何评估肝移植手术的难度，并利用找出的因素对肝移植难度进行分类。我们向肝移植外科医生提供了一个基于网络的在线欧洲调查。该调查分为三个部分：(1)参与者的人口统计学和实践情况；(2)基于受体、肝病、肿瘤治疗和技术因素的不同情况；以及(3)8个具有不同复杂程度的真实临床案例。在调查的第三部分中，被调查者被问及他们是否会进行肝移植手术，但他们不知道这些患者最终确实接受了肝移植手术。总共发出了143份邀请函，其中97人（67.8%）完成了调查。大多数参与者认为以往的自发性细菌性腹水、以往的上腹腔手术、第一节肝段肥大和肥胖症是需要进行高难度肝移植的受体因素。大多数参与者认为伴-Chiari综合征、Kasai手术、多囊性肝脏疾病、弥漫性门静脉血栓形成和开腹肝切除术史的患者进行肝移植是具有挑战性的。在8个病例中，认为肝移植需要进行的参与者比例从69%到100%不等。我们将肝移植的手术难度分为三个组：低难度组、中度难度组和高难度组，这些难度组采用了受体相关的、手术史相关的和肝病相关的变量。此调查概述了肝移植中各种情况的手术难度，对于进一步的基准和教材结果研究可能有用。版权所有©2023 Elsevier Inc. 保留所有权利。

Significant variations exist regarding the definition of difficult liver transplantation. The study goals were to investigate how liver transplant surgeons evaluate the surgical difficulty of liver transplantation and to use the identified factors to classify liver transplantation difficulty.A Web-based online European survey was presented to liver transplant surgeons. The survey was divided into 3 parts: (1) participant demographics and practices; (2) various situations based on recipient, liver disease, tumor treatment, and technical factors; and (3) 8 real-life clinical vignettes with different levels of complexity. In part 3 of the survey, respondents were asked whether they would perform liver transplantation but were not aware that these patients eventually underwent liver transplantation.A total of 143 invites were sent out, and 97 (67.8%) participants completed the survey. Most participants considered previous spontaneous bacterial peritonitis, previous supra-mesocolic surgery, hypertrophy of segment I, and obesity to be recipient factors for high-difficulty liver transplantation. Most participants considered liver transplantation to be challenging in patients with Budd-Chiari syndrome, Kasai surgery, polycystic liver disease, diffuse portal vein thrombosis, and a history of open hepatectomy. The proportion of participants indicating that liver transplantation was warranted varied across the 8 cases, from 69% to 100%. Our classification of the surgical difficulty of liver transplantation employed these recipient-related, surgical history-related, and liver disease-related variables and 3 difficulty groups were identified: low, intermediate, and high difficulty groups.This survey provides an overview of the surgical difficulty of various situations in liver transplantation that could be useful for further benchmark and textbook outcome studies.Copyright © 2023 Elsevier Inc. All rights reserved.