A Multistep, Consensus-Based Approach to Organ Allocation in Liver Transplantation: Toward a "Blended Principle Model"
U Cillo, P Burra, V Mazzaferro, L Belli, A D Pinna, M Spada, A Nanni Costa, P Toniutto, I-BELT (Italian Board of Experts in the Field of Liver Transplantation), Alfonso Avolio, Matteo Cescon, Renato Romagnoli, Walter Santaniello, Massimo Rossi, Vittorio Corno, Paolo Caraceni, Barbara Coco, Mirella Fraquelli, Maria Rendina, Mario Angelico, Stefano Fagiuoli, Raffaele Bruno, Alessandro Nanni Costa, Lorenza Ridolfi, Renato Romagnoli, Renzo Pretagostini, Antonio Amoroso, Giandomenico Biancofiore, Andrea De Gasperi, Giorgio Della Rocca, Paolo Feltracco, Agostino Colli, Dario Sacchini, Renzo Pegoraro, Ivan Gardini, Patrizia Pipitò, Carlo Maffeo, Salvatore Ricca Rossellini, E Regalia, T De Feo, U Cillo, P Burra, V Mazzaferro, L Belli, A D Pinna, M Spada, A Nanni Costa, P Toniutto, I-BELT (Italian Board of Experts in the Field of Liver Transplantation), Alfonso Avolio, Matteo Cescon, Renato Romagnoli, Walter Santaniello, Massimo Rossi, Vittorio Corno, Paolo Caraceni, Barbara Coco, Mirella Fraquelli, Maria Rendina, Mario Angelico, Stefano Fagiuoli, Raffaele Bruno, Alessandro Nanni Costa, Lorenza Ridolfi, Renato Romagnoli, Renzo Pretagostini, Antonio Amoroso, Giandomenico Biancofiore, Andrea De Gasperi, Giorgio Della Rocca, Paolo Feltracco, Agostino Colli, Dario Sacchini, Renzo Pegoraro, Ivan Gardini, Patrizia Pipitò, Carlo Maffeo, Salvatore Ricca Rossellini, E Regalia, T De Feo
Abstract
Since Italian liver allocation policy was last revised (in 2012), relevant critical issues and conceptual advances have emerged, calling for significant improvements. We report the results of a national consensus conference process, promoted by the Italian College of Liver Transplant Surgeons (for the Italian Society for Organ Transplantation) and the Italian Association for the Study of the Liver, to review the best indicators for orienting organ allocation policies based on principles of urgency, utility, and transplant benefit in the light of current scientific evidence. MELD exceptions and hepatocellular carcinoma were analyzed to construct a transplantation priority algorithm, given the inequity of a purely MELD-based system for governing organ allocation. Working groups of transplant surgeons and hepatologists prepared a list of statements for each topic, scoring their quality of evidence and strength of recommendation using the Centers for Disease Control grading system. A jury of Italian transplant surgeons, hepatologists, intensivists, infectious disease specialists, epidemiologists, representatives of patients' associations and organ-sharing organizations, transplant coordinators, and ethicists voted on and validated the proposed statements. After carefully reviewing the statements, a critical proposal for revising Italy's current liver allocation policy was prepared jointly by transplant surgeons and hepatologists.
© Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.
Source: PubMed