TY - JOUR
T1 - Location and allocation
T2 - Inequity of access to liver transplantation for patients with severe acute-on-chronic liver failure in Europe
AU - Artzner, Thierry
AU - Bernal, William
AU - the ELITA/EF-CLIF Working Group
AU - Belli, Luca S.
AU - Conti, Sara
AU - Cortesi, Paolo A.
AU - Sacleux, Sophie Caroline
AU - Pageaux, George Philippe
AU - Radenne, Sylvie
AU - Trebicka, Jonel
AU - Fernandez, Javier
AU - Perricone, Giovanni
AU - Piano, Salvatore
AU - Nadalin, Silvio
AU - Morelli, Maria C.
AU - Martini, Silvia
AU - Polak, Wojciech G.
AU - Zieniewicz, Krzysztof
AU - Toso, Christian
AU - Berenguer, Marina
AU - Iegri, Claudia
AU - Invernizzi, Federica
AU - Volpes, Riccardo
AU - Karam, Vincent
AU - Adam, René
AU - Faitot, François
AU - Rabinowich, Liane
AU - Saliba, Faouzi
AU - Meunier, Lucy
AU - Lesurtel, Mickael
AU - Uschner, Frank E.
AU - Michard, Baptiste
AU - Coilly, Audrey
AU - Meszaros, Magdalena
AU - Poinsot, Domitille
AU - Besch, Camille
AU - Schnitzbauer, Andreas
AU - De Carlis, Luciano G.
AU - Fumagalli, Roberto
AU - Angeli, Paolo
AU - Arroyo, Vincente
AU - Fondevila, Constantino
AU - Duvoux, Christophe
AU - Jalan, Rajiv
AU - Belli, Luca S.
AU - Perricone, Giovanni
AU - Viganò, Raffaella
AU - Mazzarelli, Chiara
AU - Vitale, Giovanni
AU - den Hoed, Caroline
AU - de Haan, Jubi E.
N1 - Publisher Copyright:
© 2022 American Association for the Study of Liver Diseases.
PY - 2022/9/1
Y1 - 2022/9/1
N2 - 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 I2 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.
AB - 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 I2 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.
UR - http://www.scopus.com/inward/record.url?scp=85132068511&partnerID=8YFLogxK
U2 - 10.1002/lt.26499
DO - 10.1002/lt.26499
M3 - Article
C2 - 35544360
AN - SCOPUS:85132068511
SN - 1527-6465
VL - 28
SP - 1429
EP - 1440
JO - Liver Transplantation
JF - Liver Transplantation
IS - 9
ER -