There is growing evidence that liver transplantation (LT) is the most effective treatment for acute- on- chronic liver failure grade-3 (ACLF-3). This study ex- amines whether and how this evidence translates into practice by analyzing the variability in intensive care unit (ICU) admissions, listing strategies, and LT activity for patients with ACLF-3 across transplantation centers in Europe. Consecutive patients who were admitted to the ICU with ACLF-3, whether or not they were listed and/or transplanted with ACLF-3, between 2018 and 2019 were included across 20 transplantation centers. A total of 351 patients with ACLF-3 were included: 33 had been listed prior to developing ACLF-3 and 318 had not been listed at the time of admission to the ICU. There was no cor- relation between the number of unlisted patients with ACLF-3 admitted to the ICU and the number listed or transplanted while in ACLF-3 across centers. By contrast, there was a correlation between the number of patients listed and the number transplanted while in ACLF-3. About 21% of patients who were listed while in ACLF-3 died on the waiting list or were delisted. The percent- age of LT for patients with ACLF-3 varied from 0% to 29% for those trans- planted with decompensated cirrhosis across centers (average = 8%), with an I2 index of 68% (95% confidence interval, 49%– 80%), showing substantial heterogeneity among centers. The 1-year survival for all patients with ACLF-3 was significantly higher in centers that listed and transplanted more patients with ACLF-3 (>10 patients) than in centers that listed and transplanted fewer: 36% versus 20%, respectively (p = 0.012). Patients with ACLF-3 face inequity of access to LT across Europe. Waitlisting strategies for patients with ACLF-3 influence their access to LT and, ultimately, their survival.

Location and allocation: Inequity of access to liver transplantation for patients with severe acute-on-chronic liver failure in Europe / T. Artzner, W. Bernal, L. Belli, S. Conti, P. Cortesi, S. Sacleux, G. Pageaux, S. Radenne, J. Trebicka, J. Fernandez, G. Perricone, S. Piano, S. Nadalin, M. Morelli, Martinis, W. Polak, K. Zieniewicz, C. Toso, M. Berenguer, C. Iegri, F. Invernizzi, R. Volpes, V. Karam, R. Adam, F. Faitot, L. Rabinowich, F. Saliba, L. Meunier, M. Lesurtel, Uschnerfe, B. Michard, A. Coilly, M. Meszaros, D. Poinsot, C. Besch, A. Schnitzbauer, L. De Carlis, R. Fumagalli, P. Angeli, V. Arroyo, C. Fondevila, C. Duvoux, R. Jalan, L. Belli, G. Perricone, R. Viganò, C. Mazzarelli, L. De Carlis, A. Lauterio, A. Giacomoni, F. Invernizzi, F. Donato, P. Lampertico, C. Iegri, L. Pasulo, S. Fagiuoli, M. Colledan, Morellimc, G. Vitale, S. Martini, A. Ottobrelli, D. Patrono, R. Romagnoli, R. Volpes, I. Petridis, S. Piano, P. Angeli, U. Cillo, G. Germani, P. Burra, P. Bachellier, F. Schneider, V. Castelain, P. Addeo, M. Deridder, S. Coilly, S. Faouzi, R. Adam, D. Samuel, C. Duvoux, S. Radenne, M. Lesurtel, D. Poinsot, C. Guichon, G. Pageaux, S. Faure, M. Meszaros, L. Meunier, J. Ursic-Bedoya, C. Fondevila, J. Colmenero, D. Toapanta, M. Hernández-Tejero, M. Berenguer, C. Vinaixa, W. Polak, C. den Hoed, J. de Haan, S. Nadalin, A. Penna, F. Uschner, M. Welker, A. Schnitzbauer, S. Zeuzem, Bechstein…. - In: LIVER TRANSPLANTATION. - ISSN 1527-6473. - 28:9(2022 Sep), pp. 1429-1440. [10.1002/lt.26499]

Location and allocation: Inequity of access to liver transplantation for patients with severe acute-on-chronic liver failure in Europe

P. Cortesi;P. Lampertico
Membro del Collaboration Group
;
2022

Abstract

There is growing evidence that liver transplantation (LT) is the most effective treatment for acute- on- chronic liver failure grade-3 (ACLF-3). This study ex- amines whether and how this evidence translates into practice by analyzing the variability in intensive care unit (ICU) admissions, listing strategies, and LT activity for patients with ACLF-3 across transplantation centers in Europe. Consecutive patients who were admitted to the ICU with ACLF-3, whether or not they were listed and/or transplanted with ACLF-3, between 2018 and 2019 were included across 20 transplantation centers. A total of 351 patients with ACLF-3 were included: 33 had been listed prior to developing ACLF-3 and 318 had not been listed at the time of admission to the ICU. There was no cor- relation between the number of unlisted patients with ACLF-3 admitted to the ICU and the number listed or transplanted while in ACLF-3 across centers. By contrast, there was a correlation between the number of patients listed and the number transplanted while in ACLF-3. About 21% of patients who were listed while in ACLF-3 died on the waiting list or were delisted. The percent- age of LT for patients with ACLF-3 varied from 0% to 29% for those trans- planted with decompensated cirrhosis across centers (average = 8%), with an I2 index of 68% (95% confidence interval, 49%– 80%), showing substantial heterogeneity among centers. The 1-year survival for all patients with ACLF-3 was significantly higher in centers that listed and transplanted more patients with ACLF-3 (>10 patients) than in centers that listed and transplanted fewer: 36% versus 20%, respectively (p = 0.012). Patients with ACLF-3 face inequity of access to LT across Europe. Waitlisting strategies for patients with ACLF-3 influence their access to LT and, ultimately, their survival.
Settore MED/12 - Gastroenterologia
set-2022
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/1010376
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