Frequency of and reasons behind non-listing in adult patients referred for liver transplantation: Results from a retrospective study

doi:10.5500/wjt.v14.i2.92376

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World Journal of Transplantation

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Retrospective Cohort Study

World J Transplant. Jun 18, 2024; 14(2): 92376
Published online Jun 18, 2024. doi: 10.5500/wjt.v14.i2.92376

Frequency of and reasons behind non-listing in adult patients referred for liver transplantation: Results from a retrospective study

Marco Biolato, Luca Miele, Giuseppe Marrone, Claudia Tarli, Antonio Liguori, Rosaria Calia, Giovanni Addolorato, Salvatore Agnes, Antonio Gasbarrini, Maurizio Pompili, Antonio Grieco

Marco Biolato, Luca Miele, Giuseppe Marrone, Claudia Tarli, Antonio Liguori, Rosaria Calia, Giovanni Addolorato, Salvatore Agnes, Antonio Gasbarrini, Maurizio Pompili, Antonio Grieco, Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy

Marco Biolato, Luca Miele, Giuseppe Marrone, Claudia Tarli, Antonio Liguori, Rosaria Calia, Giovanni Addolorato, Salvatore Agnes, Antonio Gasbarrini, Maurizio Pompili, Antonio Grieco, Department of Translational Medicine and Surgery, Catholic University of Sacred Heart, Rome 00168, Italy

Author contributions: Biolato M designed the study and wrote the paper; Marrone G, and Tarli C collected the data; Liguori A and Miele L analyzed the data; Calia R, Addolorato G, Pompili M, Agnes S, Gasbarrini A, and Grieco A revised the manuscript with an important intellectual contribution.

Institutional review board statement: The study was approved by the Institutional Review Board of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, on 04 July 2019 Prot. 20048/19.

Informed consent statement: All subjects understood and agreed to the study protocol and voluntarily signed the informed consent form.

Conflict-of-interest statement: Dr. Biolato has nothing to disclose.

Data sharing statement: No additional data are available.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Corresponding author: Marco Biolato, MD, PhD, Staff Physician, Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome 00168, Italy. marco.biolato@policlinicogemelli.it

Received: January 23, 2024
Revised: April 12, 2024
Accepted: April 26, 2024
Published online: June 18, 2024
Processing time: 142 Days and 13.2 Hours

Abstract

BACKGROUND

Few studies have evaluated the frequency of and the reasons behind the refusal of listing liver transplantation candidates.

AIM

To assess the ineligibility rate for liver transplantation and its motivations.

METHODS

A single-center retrospective study was conducted on adult patients which entailed a formal multidisciplinary assessment for liver transplantation eligibility. The predictors for listing were evaluated using multivariable logistic regression.

RESULTS

In our center, 314 patients underwent multidisciplinary work-up before liver transplantation enlisting over a three-year period. The most frequent reasons for transplant evaluation were decompensated cirrhosis (51.6%) and hepatocellular carcinoma (35.7%). The non-listing rate was 53.8% and the transplant rate was 34.4% for the whole cohort. Two hundred and five motivations for ineligibility were collected. The most common contraindications were psychological (9.3%), cardiovascular (6.8%), and surgical (5.9%). Inappropriate or premature referral accounted for 76 (37.1%) cases. On multivariable analysis, a referral from another hospital (OR: 2.113; 95%CI: 1.259–3.548) served as an independent predictor of non-listing.

CONCLUSION

A non-listing decision occurred in half of our cohort and was based on an inappropriate or premature referral in one case out of three. The referral from another hospital was taken as a strong predictor of non-listing.

Keywords: Controindication; Eligibility; Evaluation; Referral; Personalized medicine

Core Tip: Because of organ shortage and the need to optimize graft survival, patient candidates for liver transplantation must undergo an intensive multidisciplinary work-up to determine their suitability for registration on the waitlist. Few studies have evaluated the ineligibility rate for liver transplantation and its motivations. In this single-center, retrospective cohort study, the observed non-listing rate was 53.8% and about one out of three non-listing reasons was an inappropriate or premature referral. The external referral was a predictor of non-listing, so the betterment of the education and the training of referring physicians is recommended.