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

Autor: Artzner T; Service de Réanimation Médicale Hôpital de Hautepierre Strasbourg France Liver Intensive Therapy Unit, Institute of Liver Studies Kings College Hospital London UK Hepatology and Gastroenterology Unit ASST GOM Niguarda Milan Italy Value-Based Healthcare Unit IRCCS Multi Medica Sesto San Giovanni Italy Research Centre on Public Health (CESP) University of Milan-Bicocca Monza Italy AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire Unité INSERM 1193, Université Paris-Saclay Villejuif France Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital University of Montpellier France Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit HCL Hôpital de la Croix-Rousse Lyon France Translational Hepatology, Department of Internal Medicine Goethe University Frankfurt Germany European Foundation for the Study of Chronic Liver Failure (EF Clif) Barcelona Spain Liver ICU, Liver Unit, Institute of Digestive and Metabolic Diseases Hospital Clinic, University of Barcelona, IDIBAPS and CIBERehd Barcelona Spain School of Medicine and Surgery University of Milano-Bicocca Milan Italy Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine University of Padova Padova Italy Department of General, Visceral and Transplant Surgery University Hospital Tübingen Germany IRCCS Azienda Ospedaliero-Universitaria di Bologna Bologna Italy Gastro-hepatology Unit, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza di Torino University of Torino Torino Italy University Medical Center Rotterdam Department of Surgery, Division of HPB and Transplant Surgery Erasmus MC, Transplant Institute Rotterdam the Netherlands Department of General, Transplant and Liver Surgery Medical University of Warsaw Warsaw Poland Division of Abdominal Surgery, Department of Surgery Geneva University Hospitals Geneva Switzerland Hepatology and Liver Transplantation Unit CIBEREHD, Hospital General Universitario Gregorio Marañón, Universidad Complutense Madrid Spain Faculty of Medicine La Fe University Hospital Valencia Spain Gastroenterology Unit Papa Giovanni XXIII Hospital Bergamo Italy Division of Gastroenterology and Hepatology, CRC 'A. M. and A. Migliavacca' Center for Liver Disease Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy Hepatology and Gastroenterology Unit ISMETT-IRCCS Palermo Italy European Liver Transplant Registry Centre Hépato-Biliaire Hôpital Universitaire Paul-Brousse Villejuif France Service de Chirurgie Hépato-Biliaire et Transplantation Hépatique Hôpital de Hautepierre Strasbourg France Department of Digestive Surgery and Liver Transplantation, Croix Rousse Hospital, Hospices Civils de Lyon University of Lyon I Lyon France General Surgery and Transplantation Unit ASST GOM Niguarda Milan Italy Department of Anesthesia, Critical Care, ASST GOM Niguarda, School of Medicine and Surgery University of Milano-Bicocca Milan Italy HPB Surgery and Transplantation Hospital Universitario La Paz Madrid Spain Service d'Hepatologie Hôpital Henri Mondor Créteil France Liver Failure Group, Institute for Liver and Digestive Health UCL Medical School London UK., Bernal W, Belli LS, Conti S, Cortesi PA, Sacleux SC, Pageaux GP, Radenne S, Trebicka J, Fernandez J, Perricone G, Piano S, Nadalin S, Morelli MC, Martini S, Polak WG, 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 FE, Michard B, Coilly A, Meszaros M, Poinsot D, Besch C, Schnitzbauer A, De Carlis LG, Fumagalli R, Angeli P, Arroyo V, Fondevila C, Duvoux C, Jalan R, Belli LS, Perricone G, Viganò R, Mazzarelli C, De Carlis LG, Lauterio A, Giacomoni A, Invernizzi F, Donato F, Lampertico P, Iegri C, Pasulo L, Fagiuoli S, Colledan M, Morelli MC, 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, Coilly SCSA, Faouzi S, Adam R, Samuel D, Duvoux C, Radenne S, Lesurtel M, Poinsot D, Guichon C, Pageaux GP, Faure S, Meszaros M, Meunier L, Ursic-Bedoya J, Fondevila C, Colmenero J, Toapanta D, Hernández-Tejero M, Berenguer M, Vinaixa C, Polak WG, den Hoed C, de Haan JE, Nadalin S, Penna AD, Uschner FE, 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
Jazyk: angličtina
Zdroj: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2022 Sep; Vol. 28 (9), pp. 1429-1440. Date of Electronic Publication: 2022 Jun 16.
DOI: 10.1002/lt.26499
Abstrakt: 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 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 correlation 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 percentage of LT for patients with ACLF-3 varied from 0% to 29% for those transplanted with decompensated cirrhosis across centers (average = 8%), with an I 2 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.
(© 2022 American Association for the Study of Liver Diseases.)
Databáze: MEDLINE
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