In collaboration with the European Liver and Intestine Transplant Association (ELITA), an online questionnaire was designed to learn about actual obstacles to liver transplantation and current practice in transplant centers participating in the CHANCE study.

The study published on 5 November 2022 in Journal of Hepatology anonymously surveyed 1031 transplant doctors (including hepatologists, intensivists, anesthesiologists and surgeons) and the first 100 responses analyzed. The majority of respondents (65%) reported that fewer than 5 patients with ACLF-3 were transplanted in their center (with 58% of the respondents being residents of centers performing more than 50 liver transplantations per year).

Most respondents (66%) considered there is sufficient evidence in the literature to support liver transplantation in patients with ACLF-3, yet 70% of the respondents declared patients with ACLF-3 not having adequate access to liver transplantation. While a few respondents reported that colleagues at their own transplant center were hesitant to include critically ill patients with cirrhosis on the waiting list, most respondents identified physicians who referred patients to liver transplantation centers unwilling to transplant patients with ACLF-3. According to the survey, anesthesiologists and intensivists were the professional groups most unwilling to consider these patients for liver transplantation, followed by surgeons and hepatologists.

Some respondents (48) reported that the average time on waiting list in their center was too long for patients with ACLF-3 and the majority (58 respondents) agreed that prioritization of patients with ACLF-3 was not sufficient. Most respondents (82) claimed for evidence-based organ allocation strategies to yield improved equity in access to liver transplantation and exclude only those patients that are too sick at the time of listing.

The authors concluded that there are inconsistencies between the existing clinical evidence and current practice regarding access to liver transplantation for patients with ACLF-3 and called for a positive attitude towards critically ill patients with cirrhosis that would benefit from access to liver transplantation.

Publication information

Artzner, T., Belli, L.S.; Faitot, F., Jalan, R. Attitudes toward liver transplantation for ACLF-3 patients determine equity of access. J. Hepatol. 2022. DOI: 10.1016/j.jhep.2022.10.029