Location and allocation: Inequity of access to liver transplantation for patients with severe acute-on-chronic liver failure in Europe
Corresponding Author
Thierry Artzner
Service de Réanimation Médicale, Hôpital de Hautepierre, Strasbourg, France
Correspondence
Thierry Artzner, Service de Réanimation Médicale, Hôpital de Hautepierre, Strasbourg, France.
Email: [email protected]
Search for more papers by this authorWilliam Bernal
Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, UK
Search for more papers by this authorLuca S. Belli
Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milan, Italy
Search for more papers by this authorSara Conti
Value-Based Healthcare Unit, IRCCS Multi Medica, Sesto San Giovanni, Italy
Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
Search for more papers by this authorPaolo A. Cortesi
Value-Based Healthcare Unit, IRCCS Multi Medica, Sesto San Giovanni, Italy
Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
Search for more papers by this authorSophie-Caroline Sacleux
AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Unité INSERM 1193, Université Paris-Saclay, Villejuif, France
Search for more papers by this authorGeorge-Philippe Pageaux
Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, France
Search for more papers by this authorSylvie Radenne
Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, HCL Hôpital de la Croix-Rousse, Lyon, France
Search for more papers by this authorJonel Trebicka
Translational Hepatology, Department of Internal Medicine, Goethe University, Frankfurt, Germany
European Foundation for the Study of Chronic Liver Failure (EF Clif), Barcelona, Spain
Search for more papers by this authorJavier Fernandez
Liver ICU, Liver Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, IDIBAPS and CIBERehd, Barcelona, Spain
School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
Search for more papers by this authorGiovanni Perricone
Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milan, Italy
Search for more papers by this authorSalvatore Piano
Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine, University of Padova, Padova, Italy
Search for more papers by this authorSilvio Nadalin
Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Germany
Search for more papers by this authorMaria C. Morelli
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Search for more papers by this authorSilvia Martini
Gastro-hepatology Unit, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
Search for more papers by this authorWojciech G. Polak
University Medical Center Rotterdam Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, Transplant Institute, Rotterdam, the Netherlands
Search for more papers by this authorKrzysztof Zieniewicz
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorChristian Toso
Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
Search for more papers by this authorMarina Berenguer
Hepatology and Liver Transplantation Unit, CIBEREHD, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
Faculty of Medicine, La Fe University Hospital, Valencia, Spain
Search for more papers by this authorClaudia Iegri
Gastroenterology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
Search for more papers by this authorFederica Invernizzi
Division of Gastroenterology and Hepatology, CRC “A. M. and A. Migliavacca” Center for Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Search for more papers by this authorRiccardo Volpes
Hepatology and Gastroenterology Unit, ISMETT-IRCCS, Palermo, Italy
Search for more papers by this authorVincent Karam
European Liver Transplant Registry, Centre Hépato-Biliaire Hôpital Universitaire Paul-Brousse, Villejuif, France
Search for more papers by this authorRené Adam
European Liver Transplant Registry, Centre Hépato-Biliaire Hôpital Universitaire Paul-Brousse, Villejuif, France
Search for more papers by this authorFrançois Faitot
Service de Chirurgie Hépato-Biliaire et Transplantation Hépatique, Hôpital de Hautepierre, Strasbourg, France
Search for more papers by this authorLiane Rabinowich
Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, UK
Search for more papers by this authorFaouzi Saliba
AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Unité INSERM 1193, Université Paris-Saclay, Villejuif, France
Search for more papers by this authorLucy Meunier
Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, France
Search for more papers by this authorMickael Lesurtel
Department of Digestive Surgery and Liver Transplantation, Croix Rousse Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
Search for more papers by this authorFrank E. Uschner
Translational Hepatology, Department of Internal Medicine, Goethe University, Frankfurt, Germany
Search for more papers by this authorBaptiste Michard
Service de Chirurgie Hépato-Biliaire et Transplantation Hépatique, Hôpital de Hautepierre, Strasbourg, France
Search for more papers by this authorAudrey Coilly
AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Unité INSERM 1193, Université Paris-Saclay, Villejuif, France
Search for more papers by this authorMagdalena Meszaros
Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, France
Search for more papers by this authorDomitille Poinsot
Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, HCL Hôpital de la Croix-Rousse, Lyon, France
Search for more papers by this authorCamille Besch
Service de Chirurgie Hépato-Biliaire et Transplantation Hépatique, Hôpital de Hautepierre, Strasbourg, France
Search for more papers by this authorAndreas Schnitzbauer
Translational Hepatology, Department of Internal Medicine, Goethe University, Frankfurt, Germany
Search for more papers by this authorLuciano G. De Carlis
School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
General Surgery and Transplantation Unit, ASST GOM Niguarda, Milan, Italy
Search for more papers by this authorRoberto Fumagalli
Department of Anesthesia, Critical Care, ASST GOM Niguarda, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
Search for more papers by this authorPaolo Angeli
Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine, University of Padova, Padova, Italy
Search for more papers by this authorVincente Arroyo
European Foundation for the Study of Chronic Liver Failure (EF Clif), Barcelona, Spain
Search for more papers by this authorConstantino Fondevila
HPB Surgery and Transplantation, Hospital Universitario La Paz, Madrid, Spain
Search for more papers by this authorChristophe Duvoux
Service d'Hepatologie, Hôpital Henri Mondor, Créteil, France
Search for more papers by this authorRajiv Jalan
European Foundation for the Study of Chronic Liver Failure (EF Clif), Barcelona, Spain
Liver Failure Group, Institute for Liver and Digestive Health, UCL Medical School, London, UK
Search for more papers by this authorfor the ELITA/EF-CLIF Working Group
Search for more papers by this authorCorresponding Author
Thierry Artzner
Service de Réanimation Médicale, Hôpital de Hautepierre, Strasbourg, France
Correspondence
Thierry Artzner, Service de Réanimation Médicale, Hôpital de Hautepierre, Strasbourg, France.
Email: [email protected]
Search for more papers by this authorWilliam Bernal
Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, UK
Search for more papers by this authorLuca S. Belli
Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milan, Italy
Search for more papers by this authorSara Conti
Value-Based Healthcare Unit, IRCCS Multi Medica, Sesto San Giovanni, Italy
Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
Search for more papers by this authorPaolo A. Cortesi
Value-Based Healthcare Unit, IRCCS Multi Medica, Sesto San Giovanni, Italy
Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
Search for more papers by this authorSophie-Caroline Sacleux
AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Unité INSERM 1193, Université Paris-Saclay, Villejuif, France
Search for more papers by this authorGeorge-Philippe Pageaux
Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, France
Search for more papers by this authorSylvie Radenne
Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, HCL Hôpital de la Croix-Rousse, Lyon, France
Search for more papers by this authorJonel Trebicka
Translational Hepatology, Department of Internal Medicine, Goethe University, Frankfurt, Germany
European Foundation for the Study of Chronic Liver Failure (EF Clif), Barcelona, Spain
Search for more papers by this authorJavier Fernandez
Liver ICU, Liver Unit, Institute of Digestive and Metabolic Diseases, Hospital Clinic, University of Barcelona, IDIBAPS and CIBERehd, Barcelona, Spain
School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
Search for more papers by this authorGiovanni Perricone
Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milan, Italy
Search for more papers by this authorSalvatore Piano
Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine, University of Padova, Padova, Italy
Search for more papers by this authorSilvio Nadalin
Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Germany
Search for more papers by this authorMaria C. Morelli
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Search for more papers by this authorSilvia Martini
Gastro-hepatology Unit, Azienda Ospedaliera Universitaria, Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
Search for more papers by this authorWojciech G. Polak
University Medical Center Rotterdam Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, Transplant Institute, Rotterdam, the Netherlands
Search for more papers by this authorKrzysztof Zieniewicz
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
Search for more papers by this authorChristian Toso
Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
Search for more papers by this authorMarina Berenguer
Hepatology and Liver Transplantation Unit, CIBEREHD, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
Faculty of Medicine, La Fe University Hospital, Valencia, Spain
Search for more papers by this authorClaudia Iegri
Gastroenterology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
Search for more papers by this authorFederica Invernizzi
Division of Gastroenterology and Hepatology, CRC “A. M. and A. Migliavacca” Center for Liver Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Search for more papers by this authorRiccardo Volpes
Hepatology and Gastroenterology Unit, ISMETT-IRCCS, Palermo, Italy
Search for more papers by this authorVincent Karam
European Liver Transplant Registry, Centre Hépato-Biliaire Hôpital Universitaire Paul-Brousse, Villejuif, France
Search for more papers by this authorRené Adam
European Liver Transplant Registry, Centre Hépato-Biliaire Hôpital Universitaire Paul-Brousse, Villejuif, France
Search for more papers by this authorFrançois Faitot
Service de Chirurgie Hépato-Biliaire et Transplantation Hépatique, Hôpital de Hautepierre, Strasbourg, France
Search for more papers by this authorLiane Rabinowich
Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, UK
Search for more papers by this authorFaouzi Saliba
AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Unité INSERM 1193, Université Paris-Saclay, Villejuif, France
Search for more papers by this authorLucy Meunier
Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, France
Search for more papers by this authorMickael Lesurtel
Department of Digestive Surgery and Liver Transplantation, Croix Rousse Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
Search for more papers by this authorFrank E. Uschner
Translational Hepatology, Department of Internal Medicine, Goethe University, Frankfurt, Germany
Search for more papers by this authorBaptiste Michard
Service de Chirurgie Hépato-Biliaire et Transplantation Hépatique, Hôpital de Hautepierre, Strasbourg, France
Search for more papers by this authorAudrey Coilly
AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Unité INSERM 1193, Université Paris-Saclay, Villejuif, France
Search for more papers by this authorMagdalena Meszaros
Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Saint Eloi Hospital, University of Montpellier, France
Search for more papers by this authorDomitille Poinsot
Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, HCL Hôpital de la Croix-Rousse, Lyon, France
Search for more papers by this authorCamille Besch
Service de Chirurgie Hépato-Biliaire et Transplantation Hépatique, Hôpital de Hautepierre, Strasbourg, France
Search for more papers by this authorAndreas Schnitzbauer
Translational Hepatology, Department of Internal Medicine, Goethe University, Frankfurt, Germany
Search for more papers by this authorLuciano G. De Carlis
School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
General Surgery and Transplantation Unit, ASST GOM Niguarda, Milan, Italy
Search for more papers by this authorRoberto Fumagalli
Department of Anesthesia, Critical Care, ASST GOM Niguarda, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
Search for more papers by this authorPaolo Angeli
Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine, University of Padova, Padova, Italy
Search for more papers by this authorVincente Arroyo
European Foundation for the Study of Chronic Liver Failure (EF Clif), Barcelona, Spain
Search for more papers by this authorConstantino Fondevila
HPB Surgery and Transplantation, Hospital Universitario La Paz, Madrid, Spain
Search for more papers by this authorChristophe Duvoux
Service d'Hepatologie, Hôpital Henri Mondor, Créteil, France
Search for more papers by this authorRajiv Jalan
European Foundation for the Study of Chronic Liver Failure (EF Clif), Barcelona, Spain
Liver Failure Group, Institute for Liver and Digestive Health, UCL Medical School, London, UK
Search for more papers by this authorfor the ELITA/EF-CLIF Working Group
Search for more papers by this authorThierry Artzner, William Bernal, and Luca S. Belli are joint first authors.
Constantino Fondevila, Christophe Duvoux, and Rajiv Jalan are joint senior authors.
SEE EDITORIAL ON PAGE 1419
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.
CONFLICT OF INTEREST
Paolo Angeli advises, is on the speakers' bureau for, and received grants from BioVie; advises and is on the speakers' bureau for Grifols; is on the speakers' bureau for and received grants from Gilead Italy; on the speakers' bureau for Roche and Pfizer; and advises CSL Behring. Marina Berenguer consults for Intercept, AbbVie, and Orphalan and has received grants from Gilead. Costantino Fondevila received grants from Guangdong Shunde Innovative Design Institute. Rajiv Jalan owns stock and intellectual property rights in, is employed by, consults for, advises, and received grants from Yaqrit Ltd. and consults for, advises, and received grants from Grifols. Vincente Arroyo advises Grifols.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Supporting Information
| Filename | Description |
|---|---|
| LT26499-sup-0001-Figure_S1.docxWord 2007 document , 1.1 MB |
Figure S1 |
| LT26499-sup-0002-supinfo.docxWord 2007 document , 1.1 MB |
Appendix S1 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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