Tommaso Maria Manzia, Silvia Trapani, Alessandra Nardi, Andrea Ricci, Ilaria Lenci, Bruno Sensi, Roberta Angelico, Tullia Maria De Feo, Salvatore Agnes, Enzo Andorno, Umberto Baccarani, Amedeo Carraro, Matteo Cescon, Umberto Cillo, Michele Colledan, Domenico Pinelli, Luciano De Carlis, Paolo De Simone, Davide Ghinolfi, Fabrizio Di Benedetto, Giuseppe Maria Ettorre, Salvatore Gruttadauria, Luigi Giovanni Lupo, Francesco Tandoi, Vincenzo Mazzaferro, Renato Romagnoli, Giorgio Rossi, Lucio Caccamo, Massimo Rossi, Marco Spada, Giovanni Vennarecci, Marco Vivarelli, Fausto Zamboni, Giuseppe Tisone, Massimo Cardillo, Mario Angelico
{"title":"Fairness and pitfalls of the Italian waiting list for elective liver transplantation: The ECALITA registry study.","authors":"Tommaso Maria Manzia, Silvia Trapani, Alessandra Nardi, Andrea Ricci, Ilaria Lenci, Bruno Sensi, Roberta Angelico, Tullia Maria De Feo, Salvatore Agnes, Enzo Andorno, Umberto Baccarani, Amedeo Carraro, Matteo Cescon, Umberto Cillo, Michele Colledan, Domenico Pinelli, Luciano De Carlis, Paolo De Simone, Davide Ghinolfi, Fabrizio Di Benedetto, Giuseppe Maria Ettorre, Salvatore Gruttadauria, Luigi Giovanni Lupo, Francesco Tandoi, Vincenzo Mazzaferro, Renato Romagnoli, Giorgio Rossi, Lucio Caccamo, Massimo Rossi, Marco Spada, Giovanni Vennarecci, Marco Vivarelli, Fausto Zamboni, Giuseppe Tisone, Massimo Cardillo, Mario Angelico","doi":"10.1016/j.dld.2024.08.039","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The challenge of transplant waiting-lists is to provide organs for all candidates while maintaining efficiency and equity.</p><p><strong>Aims: </strong>We investigated the probability of being transplanted or of waiting-list dropout in Italy.</p><p><strong>Methods: </strong>Data from 12,749 adult patients waitlisted for primary liver-transplantation from January 2012 to December 2022 were collected from the National Transplant-Registry.The cohort was divided into Eras:1 (2012-2014);2 (2015-2018);and 3 (2019-2022).</p><p><strong>Results: </strong>The one-year probability of undergoing transplant increased (67.6 % in Era 1vs73.8 % in Era 3,p < 0001) with a complementary 46 % decrease in waiting-list failures. Patients with hepatocellular-carcinoma were transplanted more often than cirrhotics[at model for end-stage liver-disease (MELD)-15:HR = 1.28,95 %CI:1.21-1.35;at MELD-25:HR = 1.04,95 %CI:0.92-1.19) and those with other indications (at MELD-15:HR = 1.27,95 %CI:1.11-1.46) across all eras. Candidates with Hepatitis-B-virus (HBV)related disease had a greater probability of transplant than those with Hepatitis-C virus-related (HR = 1.13,95 %CI:1.07-1.20), alcohol-related (HR = 1.13,95 %CI:1.05-1.21), and metabolic-related (HR = 1.18,95 %CI:1.09-1.28)disease. Waiting-list failures increased by 27 % every 5 MELD-points and by 14 % for every 5-year increase in recipient-age and decreased by 10 % with each 10-cm increase in stature. Blood-group O patients showed the highest probability of waiting-list failure (HR = 1.28,95 %CI:1.15-1.43).</p><p><strong>Conclusions: </strong>Liver-transplantation waiting-list success-rates have significantly improved in Italy, with patients with hepatocellular-carcinoma and/or HBV-related diseases being favored. High MELD-score, old-age, short-stature, and blood-group O were significant risk-factors for waiting-list failure. Efforts to improve organ-allocation and prioritization-policies are underway.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":4.0000,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestive and Liver Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.dld.2024.08.039","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The challenge of transplant waiting-lists is to provide organs for all candidates while maintaining efficiency and equity.
Aims: We investigated the probability of being transplanted or of waiting-list dropout in Italy.
Methods: Data from 12,749 adult patients waitlisted for primary liver-transplantation from January 2012 to December 2022 were collected from the National Transplant-Registry.The cohort was divided into Eras:1 (2012-2014);2 (2015-2018);and 3 (2019-2022).
Results: The one-year probability of undergoing transplant increased (67.6 % in Era 1vs73.8 % in Era 3,p < 0001) with a complementary 46 % decrease in waiting-list failures. Patients with hepatocellular-carcinoma were transplanted more often than cirrhotics[at model for end-stage liver-disease (MELD)-15:HR = 1.28,95 %CI:1.21-1.35;at MELD-25:HR = 1.04,95 %CI:0.92-1.19) and those with other indications (at MELD-15:HR = 1.27,95 %CI:1.11-1.46) across all eras. Candidates with Hepatitis-B-virus (HBV)related disease had a greater probability of transplant than those with Hepatitis-C virus-related (HR = 1.13,95 %CI:1.07-1.20), alcohol-related (HR = 1.13,95 %CI:1.05-1.21), and metabolic-related (HR = 1.18,95 %CI:1.09-1.28)disease. Waiting-list failures increased by 27 % every 5 MELD-points and by 14 % for every 5-year increase in recipient-age and decreased by 10 % with each 10-cm increase in stature. Blood-group O patients showed the highest probability of waiting-list failure (HR = 1.28,95 %CI:1.15-1.43).
Conclusions: Liver-transplantation waiting-list success-rates have significantly improved in Italy, with patients with hepatocellular-carcinoma and/or HBV-related diseases being favored. High MELD-score, old-age, short-stature, and blood-group O were significant risk-factors for waiting-list failure. Efforts to improve organ-allocation and prioritization-policies are underway.
期刊介绍:
Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD).
Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology.
Contributions consist of:
Original Papers
Correspondence to the Editor
Editorials, Reviews and Special Articles
Progress Reports
Image of the Month
Congress Proceedings
Symposia and Mini-symposia.