A growing need has been identified for the integration of nurse practitioners (NPs) and physician assistants (PAs) into hepatology and liver transplant practices because of the growing patient population. Implementing comprehensive training programs to enhance NP and PA skills for these specialties is necessary, according to research published in Liver Transplant.

At this time, there are 248,000 NPs and 123,000 PAs in the United States, who provide care in approximately 1.02 billion and 400 million patient visits, respectively, every year. Some specialties, including hepatology and liver transplant, have pursued efforts to expand the NP and PA scope of practice, keeping in mind the state law limitations that may exist.

The effect of NPs and PAs in a liver transplant practice was evaluated by assigning them to either a medical or surgical role. Results showed that graft outcomes improved and patient survival rates continued to be at or above expected values after patients received care from an NP or PA. Because of this, several institutions have integrated PAs and NPs as a part of their hepatology and liver transplant team.

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The American Association for the Study of Liver Diseases now offers a fellowship program to train NPs and PAs in the field of hepatology and liver transplant. These clinicians are integrated into surgical and medical teams and learn to become providers in hepatitis C clinics, pre- and postpatient care, outpatient clinics, hepatobiliary surgery clinics, inpatient medical liver transplant services, inpatient hepatobiliary services, and intensive care transplant units. These providers learn to perform procedures including paracentesis, thoracentesis, and placement of central lines. NPs and PAs are also urged to incorporate nonpharmacologic therapies into the practice, such as mindfulness-based stress reduction programs.

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Mentorship, as well as an adequate feedback mechanism, is necessary to evaluate NP/PA competency. Evaluation should include patient care, professionalism, systems-based practice, interpersonal communication, medical/clinical knowledge, and practice-based learning and improvement. The evaluation should also identify areas of improvement and stimulate professional growth.

“Comprehensive training and adequate feedback can provide institutions with essential tools to improve and enhance NP and PA practice,” the authors concluded. “Further studies to assess appropriate training, effective evaluation tools, and quality outcomes are needed.”


Chaney AJ, Yataco ML. The emerging role of nurse practitioners and physician assistants in liver transplantation [published online April 23, 2019]. Liver Transpl. doi:10.1002/lt.25474