Biolato M, Miele L, Marrone G, Tarli C, Liguori A, Calia R, Addolorato G, Agnes S, Gasbarrini A, Pompili M, Grieco A. Frequency of and reasons behind non-listing in adult patients referred for liver transplantation: Results from a retrospective study. World J Transplant 2024; 14(2): 92376 [PMID: 38947971 DOI: 10.5500/wjt.v14.i2.92376]
Corresponding Author of This Article
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
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
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.
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.
