Split-liver activity in an Italian transplant program: An update

12nonenoneDe Feo Tullia M.; Colledan Michele; Andorno Enzo; De Carlis Luciano G.; Cillo Umberto; Rossi Giorgio; Baccarani U; Regalia Enrico; Donataccio Matteo; Risaliti Andrea; Di Silvestre Adriana; Scalamogna MarioDe Feo Tullia, M.; Colledan, Michele; Andorno, Enzo; De Carlis Luciano, G.; Cillo, Umberto; Rossi, Giorgio; Baccarani, Umberto; Regalia, Enrico; Donataccio, Matteo; Risaliti, Andrea; Di Silvestre, Adriana; Scalamogna, Mari

Preliminary Analysis of the Impact of COVID-19 Outbreak on Italian Liver Transplant Programs

Liver Transplant Programs in Italy have faced a sequela of management and clinical decision-making problems due to the high incidence in some regions of the country of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). The Italian Society for Organ Transplantation (SITO) and the Board of Liver Transplant Program Directors issued a survey to assess the initial impact of this pandemic event on the routine activity of 22 Italian Liver Transplant Programs. One hundred percent of participants completed the survey within a few days. The analysis is presented dividing the centers in two macro-areas: north-central Italy and south-central Italy. The reason for this is that the two areas had a different incidence of the infection and because they have distinctive rates of cadaveric donation. Overall, all centers remained open although a reduction in the activity was noted. Transplant Programs reduced their outpatient activity both in terms of pre-transplant evaluation (68% of the centers) and transplant recipient follow-up (100%); a reduction in transplant activity was observed in the first two weeks of March only in the north-central macro area (23 LTs vs 39 in 2018 and 60 in 2019); overall, SARS-CoV-2 infection was registered for 24 liver transplant recipients and 37 health care providers in liver transplant units. In the perspective of the increasing magnitude of the epidemic, more data will be required to define appropriate strategies for the increasingly complex management of liver transplant patients

Infectious complications in liver transplant recipients in Italy: Logistic and research projects Complicanze infettive nel trapianto di fegato in Italia: Stato attuale e prospettive di studio

The impact of infections in orthotopic liver transplantation (OLT) is remarkable. Studies have shown that about 60% of patient may develop at least 1 infectious episode during the first 3 months after transplant. Within the frame of a Finalized Research Project of the Italian Ministry of Health, during the year 2000 a group of investigators belonging to the major Italian Liver Transplant Centers (LTC) - 18 out of 20 Centers - met three times in Genoa with the aim of constituting a Research Group aimed at improving our knowledge of infectious complications in liver transplant recipients (PITF = Program of Infections in Liver Transplantation). The group first collected information about anti-infective procedure in LTC. The study shows that no Center is supported by a Intensive Care Unit (ICU) exclusively dedicated to the LTC, although 37% of them have a partially dedicated Unit. Surveillance cultures are routinely performed and are frequently used to adress the choice of the antibacterial and antifungal regimes. Selective Bowel Decontamination is also very common. The management of CMV infection is usually performed as indicated in international guidelines

Optimization of Donor-Recipient match and identification of the futile match cutoff. A national italian study on liver transplantation.

Intentional matching of liver transplant donor-recipient risk factors, supported by D-MELD (donor age 7 biochemical MELD), could offer a new therapeutic strategy with effects on survival. As yet, an extensive stratification of cases according to the futile transplant principle using a continous quantitative parameter has not been performed. To stratify the prognosis according to donor-recipient match and assess the predictive role of D-MELD together with covariates, a database detailing 5946 liver transplants performed in 21 Italian Centers (2002\u20132009) was analyzed. Primary endpoint was to evaluate the prognostic power of D-MELD and covariates in terms of 3-year patient survival. The futile-transplant cutoff (life-expectancy <50% at 5 years) was investigated. The database was divided into a training and a validation set. The adequacy of fit for both sets was tested using Hosmer-Lemeshow and C-statistics. Cases were stratified in ten D-MELD deciles. Significant differences among D-MELD deciles allowed regrouping them in three D-MELD classes (A 1628). D-MELD classes were used for regression analyses. At 3 years, the odds ratio (OR) for death is 2.03 (95% CI 1.44\u20132.85) in D-MELD class C versus class B (reference). The OR is 0.40 (95% CI 0.24\u2013 0.66) in D-MELD class A versus class B. Other significant covariates were HCV status (OR = 1.42; 95% CI 1.11\u20131.81), HBV status (OR = 0.69; 95% CI 0.51\u20130.93), re-transplant status (OR = 1.82; 95% CI 1.16\u2013 2.67) and low-volume transplant Center (OR = 1.48; 95% CI 1.11\u2013 1.99). Results were confirmed by Cox regressions. The \u201cfutilematch cutoff\u201d was identified only in HCV patients (D-MELD=1750, p < 0.001).Assuming the same high D-MELD value, an organ from an elderly donor is likely to fail in an old recipient or in an HCV recipient but not in an HBV recipient. The identification of predictive factors (D-MELD class and covariates) and the introduction of the futile cutoff may lead to formulate new organ-allocation policies. The futile matches should be proibited by national allocation rules. Fatal allocation of high-risk organs to high-risk patients should be avoided. Organs from young donors should not be allocated to recipients with a low biochemical MELD without additional risk factors