Scientific article
Open access

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

Published inLiver transplantation, vol. 28, no. 9, p. 1429-1440
Publication date2022-09
First online date2022-05-11

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.

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.

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 I2index 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.

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.

  • Acute-on-Chronic Liver Failure
  • Intensive care
  • Liver transplantation
  • Waiting list
Citation (ISO format)
ARTZNER, Thierry et al. Location and allocation: inequity of access to liver transplantation for patients with severe acute-on-chronic liver failure in Europe. In: Liver transplantation, 2022, vol. 28, n° 9, p. 1429–1440. doi: 10.1002/lt.26499
Main files (2)
Article (Accepted version)
Article (Published version)
Secondary files (1)
ISSN of the journal1527-6465

Technical informations

Creation05/19/2022 12:18:00 PM
First validation05/19/2022 12:18:00 PM
Update time03/16/2023 8:44:36 AM
Status update03/16/2023 8:44:31 AM
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