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

Autor: Manzia TM; Department of Surgical Science, University of Rome Tor Vergata, Hepatobiliary and Transplantation Unit, Policlinico Tor Vergata [Tor Vergata General Hospital], Rome, Italy, 00133., Trapani S; Italian National Transplant Centre, National Institute of Health, Rome, Italy, 00161., Nardi A; Department of Mathematics, University of Rome Tor Vergata, 00133, Rome, Italy., Ricci A; Italian National Transplant Centre, National Institute of Health, Rome, Italy, 00161., Lenci I; Hepatology and Transplant Unit, Fondazione Policlinico Tor Vergata [Tor Vergata General Hospital Foundation], 00133., Sensi B; Department of Surgical Science, University of Rome Tor Vergata, Hepatobiliary and Transplantation Unit, Policlinico Tor Vergata [Tor Vergata General Hospital], Rome, Italy, 00133., Angelico R; Department of Surgical Science, University of Rome Tor Vergata, Hepatobiliary and Transplantation Unit, Policlinico Tor Vergata [Tor Vergata General Hospital], Rome, Italy, 00133. Electronic address: roberta.angelico@uniroma2.it., De Feo TM; North Italy Transplant program (NITp). Transplant Coordination Unit, Fondazione IRCSS Cà Granda Ospedale Maggiore Policlinico [Cà Granda General Research Hospital], Milan, Italy, 20122., Agnes S; Department of Surgery, Transplantation Service, Catholic University of the Sacred Heart, Foundation A. Gemelli Hospital, Rome, Italy, 00136., Andorno E; Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation Unit. A.O.U. S. Martino [S. Martino University Hospital], Genoa, Italy, 16132., Baccarani U; Department of Medicine, Università Degli Studi Di Udine [University of Udine], Udine, Italy, 33100., Carraro A; Liver Transplant Unit, Department of Surgical Science, University and Hospital Trust of Verona. Azienda Ospedaliera Verona, Verona, Italy, 37129., Cescon M; Hepatobiliary and Transplant Unit, AOU Sant'Orsola IRCCS [Sant'Orsola University Research Hospital], Department of Medical and Surgical Sciences, University of Bologna, Italy, 40138., Cillo U; Hepatobiliary Surgery and Liver Transplantation Unit, University of Padua, Padua, Italy, 35135., Colledan M; Department of Organ Failure and Transplantation. Ospedale Papa Giovanni XXIII [Papa Giovanni XXIII Hospital] Bergamo, University of Milano-Bicocca, Milan, Italy, 24127., Pinelli D; Department of Organ Failure and Transplantation. Ospedale Papa Giovanni XXIII [Papa Giovanni XXIII Hospital] Bergamo, University of Milano-Bicocca, Milan, Italy, 24127., De Carlis L; Division of General Surgery & Abdominal Transplantation, ASST Grande Ospedale Metropolitano Niguarda [Niguarda Metropolitan Hospital], University of Milano-Bicocca, Milan, Italy, 20161., De Simone P; Hepatobiliary Surgery and Liver Transplantation, AOU Pisana [Pisana University Hospital], Pisa, Italy, 56124., Ghinolfi D; Hepatobiliary Surgery and Liver Transplantation, AOU Pisana [Pisana University Hospital], Pisa, Italy, 56124., Benedetto FD; Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Azienda Ospedaliera Policlinico [General Hospital], University of Modena and Reggio Emilia, Modena, Italy, 41125., Ettorre GM; Division of General Surgery and Liver Transplantation. Azienda Ospedaliera San Camillo Forlanini [San Camillo Forlanini Hospital], Rome, Italy, 00152., Gruttadauria S; Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneoper i Trapianti e Terapie ad alta specializzazione [Research Hospital - Highly-specialized Mediterranean Institute for Transplants and Therapies]), UPMC (University of Pittsburgh Medical Center), Palermo, Italy; Department of Surgery and Medical and Surgical Specialties, University of Catania, Catania, Italy, 90127., Lupo LG; General Surgery and Liver transplantation Unit, University of Bari, Bari, Italy, 70121., Tandoi F; General Surgery and Liver transplantation Unit, University of Bari, Bari, Italy, 70121., Mazzaferro V; HPB Surgery and Liver Transplantation Unit, Department of Oncology, University of Milan and Department of Surgery, Fondazione IRCCS [Research Hospital Foundation], Istituto Nazionale Tumori [National Cancer Institute], IRCCS, Milan, 20133, Italy., Romagnoli R; Liver Transplant Center, General Surgery 2 U, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy, 10126., Rossi G; Division of General Surgery and Liver Transplantation, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy, 20122., Caccamo L; Division of General Surgery and Liver Transplantation, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy, 20122., Rossi M; General Surgery and Organ Transplantation, Sapienza University of Rome, Umberto I Polyclinic of Rome, Rome, Italy, 00185., Spada M; Department of Specialized Surgery, Division of Hepato-Pancreato-Biliary Surgery and of Liver and Kidney Transplantation, Bambino Gesù Children's Hospital, IRCCS [Research Hospital], Rome, Italy, 00165., Vennarecci G; Unit of Hepatobiliary Surgery and Liver Transplant Center, Department of Gastroenterology and Transplantation, 'A. Cardarelli' Hospital, Naples, Italy, 80131., Vivarelli M; Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, AOU Ospedali Riuniti [Joint Hospitals], Ancona, Italy, 60126., Zamboni F; Department of Surgery, General and Hepatic Transplantation Surgery Unit, A.O.B. Brotzu, Cagliari, Italy, 09047., Tisone G; Department of Surgical Science, University of Rome Tor Vergata, Hepatobiliary and Transplantation Unit, Policlinico Tor Vergata [Tor Vergata General Hospital], Rome, Italy, 00133., Cardillo M; Italian National Transplant Centre, National Institute of Health, Rome, Italy, 00161., Angelico M; Hepatology and Transplant Unit, Fondazione Policlinico Tor Vergata [Tor Vergata General Hospital Foundation], 00133.
Jazyk: angličtina
Zdroj: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver [Dig Liver Dis] 2024 Sep 04. Date of Electronic Publication: 2024 Sep 04.
DOI: 10.1016/j.dld.2024.08.039
Abstrakt: 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.
Competing Interests: Conflict of interest The authors of this manuscript have no conflicts of interest to disclose.
(Copyright © 2024. Published by Elsevier Ltd.)
Databáze: MEDLINE
Externí odkaz: