Location and allocation
Thierry Artzner, William Bernal, L Belli, Sara Conti, Paolo Angelo Cortesi, Sophie‐Caroline Sacleux, G.-P. Pageaux, Sylvie Radenne, Jonel Trebicka, Javier Fernández, Giovanni Perricone, Salvatore Piano, Silvio Nadalin, Maria Cristina Morelli, Silvia Martini, Wojciech G. Polak, Krzysztof Zieniewicz, Christian Toso, Marina Berenguer, C. Iegri, Federica Invernizzi, Riccardo Volpes, Vincent Karam, René Adam, François Faitot, Liane Rabinowich, Faouzi Saliba, Lucy Meunier, Mickaël Lesurtel, Frank Erhard Uschner, Baptiste Michard, Audrey Coilly, Magdalena Meszaros, Domitille Poinsot, Camille Besch, Andreas A. Schnitzbauer, Luciano De Carlis, Roberto Fumagalli, Paolo Angeli, Vicente Arroyo, Constantino Fondevila, Christophe Duvoux, Rajiv Jalan, L Belli, Giovanni Perricone, Raffaella Viganò, Chiara Mazzarelli, Luciano De Carlis, Andrea Lauterio, Alessandro Giacomoni, Federica Invernizzi, Francesca Donato, Pietro Lampertico, C. Iegri, L. 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, René Adam, Didier Samuel, Christophe Duvoux, Sylvie Radenne, Mickaël Lesurtel, Domitille Poinsot, Céline Guichon, G.-P. 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 M. den Hoed, Jubi E. de Haan, Silvio Nadalin, Andrea Della Penna
Abstract
Background 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 ACLF-3 patients across transplant centers in Europe. Methods 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. Results 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 ACLF-3 patients admitted to the ICU and the number listed or transplanted whilst in ACLF-3 across centers. In contrast, there was a correlation between the number of patients listed and the number transplanted whilst in ACLF-3. 21% of patients who were listed whilst in ACLF-3 died on the waiting list or were delisted. The percentage of LT for ACLF-3 patients varied from 0%-29% of patients transplanted with decompensated cirrhosis across centers (average = 8%), with an I2 index of 68% (95% CI: 49%-80%), showing substantial heterogeneity among centers. The one-year survival for all patients with ACLF-3 was significantly higher in centers that listed and transplanted more ACLF-3 patients (>10 patients) than in centers that listed and transplanted fewer: respectively 36% vs. 20%, p = 0.012. Conclusion Patients with ACLF-3 face inequity of access to LT across Europe. Wait-listing strategies for ACLF-3 patients influence their access to LT and, ultimately, their survival.