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.

Cillo, U., Burra, P., Mazzaferro, V., Belli, L., Pinna, A., Spada, M., et al. (2015). A Multistep, Consensus-Based Approach to Organ Allocation in Liver Transplantation: Toward a "blended Principle Model". AMERICAN JOURNAL OF TRANSPLANTATION, 15(10), 2552-2561 [10.1111/ajt.13408].

A Multistep, Consensus-Based Approach to Organ Allocation in Liver Transplantation: Toward a "blended Principle Model"

ANGELICO, MARIO;
2015-01-01

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.
2015
Pubblicato
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MED/18 - CHIRURGIA GENERALE
Settore MED/12 - GASTROENTEROLOGIA
English
Con Impact Factor ISI
Cillo, U., Burra, P., Mazzaferro, V., Belli, L., Pinna, A., Spada, M., et al. (2015). A Multistep, Consensus-Based Approach to Organ Allocation in Liver Transplantation: Toward a "blended Principle Model". AMERICAN JOURNAL OF TRANSPLANTATION, 15(10), 2552-2561 [10.1111/ajt.13408].
Cillo, U; Burra, P; Mazzaferro, V; Belli, L; Pinna, A; Spada, M; Nanni Costa, A; Toniutto, P; Avolio, A; Cescon, M; Romagnoli, R; Santaniello, W; Rossi, M; Corno, V; Caraceni, P; Coco, B; Fraquelli, M; Rendina, M; Angelico, M; Fagiuoli, S; Bruno, R; Costa, A; Ridolfi, L; Romagnoli, R; Pretagostini, R; Amoroso, A; Biancofiore, G; De Gasperi, A; Rocca, G; Feltracco, P; Colli, A; Sacchini, D; Pegoraro, R; Gardini, I; Pipit, P; Maffeo, C; Rossellini, S
Articolo su rivista
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/132038
Citazioni
  • ???jsp.display-item.citation.pmc??? 51
  • Scopus 154
  • ???jsp.display-item.citation.isi??? 143
social impact