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

Fecha de publicación: Fecha Ahead of Print:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Artzner, Thierry
  • Bernal, William
  • Belli, Luca S.
  • Conti, Sara
  • Cortesi, Paolo A.
  • Sacleux, Sophie-Caroline
  • Pageaux, George-Philippe
  • Radenne, Sylvie
  • Trebicka, Jonel
  • Fernandez, Javier
  • Perricone, Giovanni
  • Piano, Salvatore
  • Nadalin, Silvio
  • Morelli, Maria C.
  • Martini, Silvia
  • Polak, Wojciech G.
  • Zieniewicz, Krzysztof
  • Toso, Christian
  • Iegri, Claudia
  • Invernizzi, Federica
  • Volpes, Riccardo
  • Karam, Vincent
  • Adam, Rene
  • Faitot, Francois
  • Rabinowich, Liane
  • Saliba, Faouzi
  • Meunier, Lucy
  • Lesurtel, Mickael
  • Uschner, Frank E.
  • Michard, Baptiste
  • Coilly, Audrey
  • Meszaros, Magdalena
  • Poinsot, Domitille
  • Besch, Camille
  • Schnitzbauer, Andreas
  • De Carlis, Luciano G.
  • Fumagalli, Roberto
  • Angeli, Paolo
  • Arroyo, Vincente
  • Fondevila, Constantino
  • Duvoux, Christophe
  • Jalan, Rajiv
  • ELITA/EF-CLIF working group

Grupos

Abstract

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.

Datos de la publicación

ISSN/ISSNe:
1527-6465, 1527-6473

LIVER TRANSPLANTATION  LIPPINCOTT WILLIAMS & WILKINS

Tipo:
Article
Páginas:
1429-1440
PubMed:
35544360
Factor de Impacto:
1,614 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 34

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Keywords

  • ILL CIRRHOTIC-PATIENTS

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