Fairness and pitfalls of the Italian waiting list for elective liver transplantation: The ECALITA registry study.

IF 4 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Digestive and Liver Disease Pub Date : 2024-09-04 DOI:10.1016/j.dld.2024.08.039
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
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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.

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意大利择期肝移植候选名单的公平性和隐患:ECALITA 登记研究。
背景:移植候选名单面临的挑战是在保持效率和公平的前提下为所有候选者提供器官:移植候选名单面临的挑战是在保持效率和公平的同时为所有候选者提供器官。目的:我们调查了在意大利被移植或退出候选名单的概率:方法:从国家移植登记处收集了2012年1月至2022年12月期间12749名等待初次肝移植的成年患者的数据,并将队列分为1期(2012-2014年)、2期(2015-2018年)和3期(2019-2022年):结果:一年后接受移植的概率增加了(第 1 个时代为 67.6%,第 3 个时代为 73.8%,P < 0001),同时等待名单上失败的患者也减少了 46%。在所有时代,肝细胞癌患者比肝硬化患者[在终末期肝病模型(MELD)-15:HR = 1.28,95 %CI:1.21-1.35;在MELD-25:HR = 1.04,95 %CI:0.92-1.19]和其他适应症患者(在MELD-15:HR = 1.27,95 %CI:1.11-1.46)更多接受移植。与乙型肝炎病毒(HBV)相关疾病的候选者比丙型肝炎病毒相关疾病(HR = 1.13,95 %CI:1.07-1.20)、酒精相关疾病(HR = 1.13,95 %CI:1.05-1.21)和代谢相关疾病(HR = 1.18,95 %CI:1.09-1.28)的候选者有更大的移植几率。MELD积分每增加5分,等待名单上的失败者就会增加27%;受者年龄每增加5岁,失败者就会增加14%;身材每增加10厘米,失败者就会减少10%。O血型患者出现等待失败的概率最高(HR = 1.28,95 %CI:1.15-1.43):结论:在意大利,肝移植等待成功率已显著提高,肝细胞癌和/或 HBV 相关疾病患者更受青睐。MELD评分高、年龄大、身材矮小和O型血是导致候诊失败的重要风险因素。目前正在努力改进器官分配和优先排序政策。
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来源期刊
Digestive and Liver Disease
Digestive and Liver Disease 医学-胃肠肝病学
CiteScore
6.10
自引率
2.20%
发文量
632
审稿时长
19 days
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.
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