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 , 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 , Mario Angelico","doi":"10.1016/j.dld.2024.08.039","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The challenge of transplant waiting-lists is to provide organs for all candidates while maintaining efficiency and equity.</div></div><div><h3>Aims</h3><div>We investigated the probability of being transplanted or of waiting-list dropout in Italy.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>The one-year probability of undergoing transplant increased (67.6 % in Era 1<em>vs</em>73.8 % in Era 3,<em>p</em> < 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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 408-416"},"PeriodicalIF":4.0000,"publicationDate":"2025-02-01","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://www.sciencedirect.com/science/article/pii/S1590865824009563","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
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Symposia and Mini-symposia.