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International comparison of liver transplant programmes: differences in indications, donor and recipient selection and outcome between Italy and UK
- Source :
- Liver international : official journal of the International Association for the Study of the Liver. 36(10)
- Publication Year :
- 2015
-
Abstract
- Background & aims Comparing liver transplant (LT) programmes internationally can improve outcomes by stimulating cross-national learning. Yet, comparison of crude outcomes, by using registry data, is limited by missing data, not allowing proper risk-adjustment for donor- and recipient-related factors. The objective of this study was to compare two European LT programmes based on high-quality national longitudinal databases prospectively collected in Italy and UK respectively. Methods We undertook a multicentre, international cohort study including all adults who underwent a first single organ LT in Italy (N = 1480) and the UK (N = 1003) between June 2007 and May 2009. Results Italian donors were much older compared to the UK ones. Hepatitis C virus infection and hepatocellular carcinoma had higher prevalence in the Italian cohort compared to the UK one (47.5% vs. 23.1%, and 47.2% vs. 17.1% respectively). Centres' volume differed significantly, with five centres out of seven in UK vs. only two out of 20 in Italy performing >60 transplants per year. No national strategies to drive the donor-recipient matching were identified in both countries. After appropriate adjustment, a higher risk of early transplant loss was identified in the Italian cohort, whereas no differences were found in the 3-year survival rates. Conclusions International comparison of LT programmes provides the opportunity for benchmarking between heterogeneous healthcare systems and should ideally become a vital part of national quality assurance programmes. This requires the implementation of a standardized methodology for data collection to appropriately weigh each country's patient case-mix and donor and recipients risk factors.
- Subjects :
- 0301 basic medicine
Adult
Graft Rejection
Male
medicine.medical_specialty
Carcinoma, Hepatocellular
Databases, Factual
medicine.medical_treatment
Kaplan-Meier Estimate
Liver transplantation
survival
Settore MED/01 - Statistica Medica
Donor Selection
Cohort Studies
03 medical and health sciences
Young Adult
0302 clinical medicine
medicine
Humans
Young adult
Survival rate
Aged
Hepatology
Donor selection
business.industry
Liver Neoplasms
international comparison
Hepatitis C
Benchmarking
Middle Aged
medicine.disease
United Kingdom
Surgery
Liver Transplantation
Survival Rate
030104 developmental biology
liver transplantation
Italy
Cohort
Regression Analysis
030211 gastroenterology & hepatology
Female
business
Cohort study
Demography
Subjects
Details
- ISSN :
- 14783231
- Volume :
- 36
- Issue :
- 10
- Database :
- OpenAIRE
- Journal :
- Liver international : official journal of the International Association for the Study of the Liver
- Accession number :
- edsair.doi.dedup.....3ae3198d7759637981202f8eca9c47c2