Background: 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 examines whether and how this evidence translates into practice by analyzing the variability in intensive care unit (ICU) admissions, listing strategies and LT activity for ACLF-3 patients across transplant centers in Europe. Methods: 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. Results: 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 correlation between the number of unlisted ACLF-3 patients admitted to the ICU and the number listed or transplanted whilst in ACLF-3 across centers. In contrast, there was a correlation between the number of patients listed and the number transplanted whilst in ACLF-3. 21% of patients who were listed whilst in ACLF-3 died on the waiting list or were delisted. The percentage of LT for ACLF-3 patients varied from 0%-29% of patients transplanted with decompensated cirrhosis across centers (average = 8%), with an I2 index of 68% (95% CI: 49%-80%), showing substantial heterogeneity among centers. The one-year survival for all patients with ACLF-3 was significantly higher in centers that listed and transplanted more ACLF-3 patients (>10 patients) than in centers that listed and transplanted fewer: respectively 36% vs. 20%, p = 0.012. Conclusion: Patients with ACLF-3 face inequity of access to LT across Europe. Wait-listing strategies for ACLF-3 patients influence their access to LT and, ultimately, their survival.

Artzner, T., Bernal, W., Belli, L., Conti, S., Cortesi, P., Sacleux, S., et al. (2022). Location and allocation: inequity of access to liver transplantation for patients with severe acute‐on‐chronic liver failure in Europe. LIVER TRANSPLANTATION [10.1002/lt.26499].

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

Conti, Sara;Cortesi, Paolo A;De Carlis, Luciano G;Fumagalli, Roberto;De Carlis, Luciano G;Lauterio, Andrea;Fagiuoli, Stefano;Colledan, Michele;
2022

Abstract

Background: 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 examines whether and how this evidence translates into practice by analyzing the variability in intensive care unit (ICU) admissions, listing strategies and LT activity for ACLF-3 patients across transplant centers in Europe. Methods: 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. Results: 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 correlation between the number of unlisted ACLF-3 patients admitted to the ICU and the number listed or transplanted whilst in ACLF-3 across centers. In contrast, there was a correlation between the number of patients listed and the number transplanted whilst in ACLF-3. 21% of patients who were listed whilst in ACLF-3 died on the waiting list or were delisted. The percentage of LT for ACLF-3 patients varied from 0%-29% of patients transplanted with decompensated cirrhosis across centers (average = 8%), with an I2 index of 68% (95% CI: 49%-80%), showing substantial heterogeneity among centers. The one-year survival for all patients with ACLF-3 was significantly higher in centers that listed and transplanted more ACLF-3 patients (>10 patients) than in centers that listed and transplanted fewer: respectively 36% vs. 20%, p = 0.012. Conclusion: Patients with ACLF-3 face inequity of access to LT across Europe. Wait-listing strategies for ACLF-3 patients influence their access to LT and, ultimately, their survival.
Articolo in rivista - Articolo scientifico
Scientifica
Acute-on-Chronic Liver Failure; Intensive care; Liver transplantation; Waiting list
English
Artzner, T., Bernal, W., Belli, L., Conti, S., Cortesi, P., Sacleux, S., et al. (2022). Location and allocation: inequity of access to liver transplantation for patients with severe acute‐on‐chronic liver failure in Europe. LIVER TRANSPLANTATION [10.1002/lt.26499].
Artzner, T; Bernal, W; Belli, L; Conti, S; Cortesi, P; Sacleux, S; Pageaux, G; Radenne, S; Trebicka, J; Fernandez, J; Perricone, G; Piano, S; Nadalin, S; Morelli, M; Martini, S; Polak, W; Zieniewicz, K; Toso, C; Berenguer, M; Iegri, C; Invernizzi, F; Volpes, R; Karam, V; Adam, R; Faitot, F; Rabinowich, L; Saliba, F; Meunier, L; Lesurtel, M; Uschner, F; Michard, B; Coilly, A; Meszaros, M; Poinsot, D; Besch, C; Schnitzbauer, A; De Carlis, L; Fumagalli, R; Angeli, P; Arroyo, V; Fondevila, C; Duvoux, C; Jalan, R; Belli, L; Perricone, G; Viganò, R; Mazzarelli, C; De Carlis, L; Lauterio, A; Giacomoni, A; Invernizzi, F; Donato, F; Lampertico, P; Iegri, C; Pasulo, L; Fagiuoli, S; Colledan, M; Cristina Morelli, M; Vitale, G; Martini, S; Ottobrelli, A; Patrono, D; Romagnoli, R; Volpes, R; Petridis, I; Piano, S; Angeli, P; Cillo, U; Germani, G; Burra, P; Bachellier, P; Schneider, F; Castelain, V; Addeo, P; Deridder, M; Caroline Sacleux Audrey Coilly, S; Faouzi, S; Adam, R; Samuel, D; Duvoux, C; Radenne, S; Lesurtel, M; Poinsot, D; Guichon, C; Pageaux, G; Faure, S; Meszaros, M; Meunier, L; Ursic‐bedoya, J; Fondevila, C; Colmenero, J; Toapanta, D; Hernández‐tejero, M; Berenguer, M; Vinaixa, C; Polak, W; den Hoed, C; Haan, J; Nadalin, S; Della Penna, A; Erhard Uschner, F; Welker, M; Schnitzbauer, A; Zeuzem, S; Bechstein, W; Trebicka, J; Toso, C; Goossens, N; Raszeja‐wyszomirska, J; Zieniewicz, K; Bernal, W; Rabinovich, L; Katarey, D; Agarwal, B; Jalan, R
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10281/381307
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