title: Liver Match, a prospective observational cohort study on liver transplantation in Italy: study design and current practice of donor-recipient matching.
abstract: BACKGROUND
  The Liver Match is an observational cohort study that prospectively enrolled liver transplantations performed at 20 out of 21 Italian Transplant Centres between June 2007 and May 2009. Aim of the study is to investigate the impact of donor/recipient matching on outcomes. In this report we describe the study methodology and provide a cross-sectional description of donor and recipient characteristics and of graft allocation.
  
  
  METHODS
  Adult primary transplants performed with deceased heart-beating donors were included. Relevant information on donors and recipients, organ procurement and allocation were prospectively entered in an ad hoc database within the National Transplant Centre web-based Network. Data were blindly analysed by an independent Biostatistical Board.
  
  
  RESULTS
  The study enrolled 1530 donor/recipient matches. Median donor age was 56 years. Female donors (n = 681, median 58, range 12-92 years) were older than males (n = 849, median 53, range 2-97 years, p < 0.0001). Donors older than 60 years were 42.2%, including 4.2% octogenarians. Brain death was due to non-traumatic causes in 1126 (73.6%) cases. Half of the donor population was overweight, 10.1% was obese and 7.6% diabetic. Hepatitis B core antibody (HBcAb) was present in 245 (16.0%) donors. The median Donor Risk Index (DRI) was 1.57 (>1.7 in 35.8%). The median cold ischaemia time was 7.3h (≥ 10 in 10.6%). Median age of recipients was 54 years, and 77.7% were males. Hepatocellular carcinoma (HCC) was the most frequent indication overall (44.4%), being a coindication in roughly 1/3 of cases, followed by viral cirrhosis without HCC (28.2%) and alcoholic cirrhosis without HCC (10.2%). Hepatitis C virus infection (with or without HCC) was the most frequent etiologic factor (45.9% of the whole population and 71.4% of viral-related cirrhosis), yet hepatitis B virus infection accounted for 28.6% of viral-related cirrhosis, and HBcAb positivity was found in 49.7% of recipients. The median Model for End Stage Liver Disease (MELD) at transplant was 12 in patients with HCC and 18 in those without. Multivariate analysis showed a slight but significant inverse association between DRI and MELD at transplant.
  
  
  CONCLUSIONS
  The deceased donor population in Italy has a high-risk profile compared to other countries, mainly due to older donor age. Almost half of the grafts are transplanted in recipients with HCC. Higher risk donors tend to be preferentially allocated to recipients with HCC, who are usually less ill and older. No other relevant allocation strategy is currently adopted at national level.
authors.affiliation: Hepatology and Liver Transplantation Unit, Tor Vergata University, Rome, Italy. angelico@med.uniroma2.it
authors.forename: Mario
authors.initials: M
authors.lastname: Angelico
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Stefano
authors.initials: S
authors.lastname: Fagiuoli
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: Caius
authors.initials: C
authors.lastname: Gavrila
authors.forename: Tania
authors.initials: T
authors.lastname: Marianelli
authors.forename: Alessandro Nanni
authors.initials: AN
authors.lastname: Costa
authors.forename: Alessandra
authors.initials: A
authors.lastname: Nardi
authors.forename: Mario
authors.initials: M
authors.lastname: Strazzabosco
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
authors.forename: Salvatore
authors.initials: S
authors.lastname: Agnes
authors.forename: Umberto
authors.initials: U
authors.lastname: Baccarani
authors.forename: Fulvio
authors.initials: F
authors.lastname: Calise
authors.forename: Michele
authors.initials: M
authors.lastname: Colledan
authors.forename: Oreste
authors.initials: O
authors.lastname: Cuomo
authors.forename: Luciano
authors.initials: L
authors.lastname: De Carlis
authors.forename: Matteo
authors.initials: M
authors.lastname: Donataccio
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Ettorre
authors.forename: Giorgio E
authors.initials: GE
authors.lastname: Gerunda
authors.forename: Bruno
authors.initials: B
authors.lastname: Gridelli
authors.forename: Luigi
authors.initials: L
authors.lastname: Lupo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mazzaferro
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinna
authors.forename: Andrea
authors.initials: A
authors.lastname: Risaliti
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tisone
authors.forename: Umberto
authors.initials: U
authors.lastname: Valente
authors.forename: Giorgio
authors.initials: G
authors.lastname: Rossi
authors.forename: Massimo
authors.initials: M
authors.lastname: Rossi
authors.forename: Fausto
authors.initials: F
authors.lastname: Zamboni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005355:Fibrosis / Q000601:surgery; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007558:Italy; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014850:Waiting Lists