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

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 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.

• Authors: Thierry Artzner, William Bernal, Luca S Belli, Sara Conti, Paolo A Cortesi, Sophie-Caroline Sacleux, George-Philippe Pageaux, Sylvie Radenne, Jonel Trebicka, Javier Fernandez, Giovanni Perricone, Salvatore Piano, Silvio Nadalin, Maria C Morelli, Silvia Martini, Wojciech G Polak, Krzysztof Zieniewicz, Christian Toso, Marina Berenguer, Claudia Iegri, Federica Invernizzi, Riccardo Volpes, Vincent Karam, René Adam, François Faitot, Liane Rabinowich, Faouzi Saliba, Lucy Meunier, Mickael Lesurtel, Frank E Uschner, Baptiste Michard, Audrey Coilly, Magdalena Meszaros, Domitille Poinsot, Camille Besch, Andreas Schnitzbauer, Luciano G De Carlis, Roberto Fumagalli, Paolo Angeli, Vincente Arroyo, Constantino Fondevila, Christophe Duvoux, Rajiv Jalan, Luca S Belli, Giovanni Perricone, Raffaella Viganò, Chiara Mazzarelli, Luciano G De Carlis, Andrea Lauterio, Alessandro Giacomoni, Federica Invernizzi, Francesca Donato, Pietro Lampertico, Claudia Iegri, Luisa Pasulo, Stefano Fagiuoli, Michele Colledan, Maria Cristina Morelli, Giovanni Vitale, Silvia Martini, Antonio Ottobrelli, Damiano Patrono, Renato Romagnoli, Riccardo Volpes, Ioannis Petridis, Salvatore Piano, Paolo Angeli, Umberto Cillo, Giacomo Germani, Patrizia Burra, Philippe Bachellier, Francis Schneider, Vincent Castelain, Pietro Addeo, Mathilde Deridder, Sophie Caroline Sacleux Audrey Coilly, Saliba Faouzi, Rene Adam, Didier Samuel, Christophe Duvoux, Sylvie Radenne, Mickael Lesurtel, Domitille Poinsot, Celine Guichon, George-Philippe Pageaux, Stéfanie Faure, Magdalena Meszaros, Lucy Meunier, Josè Ursic-Bedoya, Costantino Fondevila, Jorde Colmenero, David Toapanta, María Hernández-Tejero, Marina Berenguer, Carmen Vinaixa, Wojciech G Polak, Caroline den Hoed, Jubi E de Haan, Silvio Nadalin, Andrea Della Penna, Frank Erhard Uschner, Martin Welker, Andreas Schnitzbauer, Stefan Zeuzem, Wolf Bechstein, Jonel Trebicka, Christian Toso, Nicolas Goossens, Joanna Raszeja-Wyszomirska, Krzysztof Zieniewicz, William Bernal, Liane Rabinovich, Dev Katarey, Banwari Agarwal, Rajiv Jalan, ELITA/EF‐CLIF Working Group
• Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 28 Issue 9 Pg. 1429-1440 (09 2022) ISSN: 1527-6473 [Electronic] United States
• PMID: 35544360 (Publication Type: Journal Article)
• Copyright: © 2022 American Association for the Study of Liver Diseases.

Topics

• Acute-On-Chronic Liver Failure (diagnosis, surgery)
• Humans
• Intensive Care Units
• Liver Cirrhosis
• Liver Transplantation (adverse effects)
• Prognosis
• Retrospective Studies
• Treatment Outcome
• Waiting Lists