title: International comparison of liver transplant programmes: differences in indications, donor and recipient selection and outcome between Italy and UK.
abstract: Comparing liver transplant (LT) programmes internationally can improve outcomes by stimulating cross-national learning. Yet, comparison of crude outcomes, by using registry data, is limited by missing data, not allowing proper risk-adjustment for donor- and recipient-related factors. The objective of this study was to compare two European LT programmes based on high-quality national longitudinal databases prospectively collected in Italy and UK respectively.
  
  
  
  We undertook a multicentre, international cohort study including all adults who underwent a first single organ LT in Italy (N = 1480) and the UK (N = 1003) between June 2007 and May 2009.
  
  
  
  Italian donors were much older compared to the UK ones. Hepatitis C virus infection and hepatocellular carcinoma had higher prevalence in the Italian cohort compared to the UK one (47.5% vs. 23.1%, and 47.2% vs. 17.1% respectively). Centres' volume differed significantly, with five centres out of seven in UK vs. only two out of 20 in Italy performing >60 transplants per year. No national strategies to drive the donor-recipient matching were identified in both countries. After appropriate adjustment, a higher risk of early transplant loss was identified in the Italian cohort, whereas no differences were found in the 3-year survival rates.
  
  
  
  International comparison of LT programmes provides the opportunity for benchmarking between heterogeneous healthcare systems and should ideally become a vital part of national quality assurance programmes. This requires the implementation of a standardized methodology for data collection to appropriately weigh each country's patient case-mix and donor and recipients risk factors.
authors.affiliation: Liver Match Study, Associazione Italiana Studio Fegato (AISF), Rome, Italy.|National Health Service Blood and Transplant (NHSBT), Bristol, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Carbone
authors.affiliation: Liver Match Study, Associazione Italiana Studio Fegato (AISF), Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Nardi
authors.affiliation: Liver Match Study, Associazione Italiana Studio Fegato (AISF), Rome, Italy.
authors.forename: Tania
authors.initials: T
authors.lastname: Marianelli
authors.affiliation: National Health Service Blood and Transplant (NHSBT), Bristol, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Martin
authors.affiliation: National Health Service Blood and Transplant (NHSBT), Bristol, UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Hudson
authors.affiliation: National Health Service Blood and Transplant (NHSBT), Bristol, UK.
authors.forename: David
authors.initials: D
authors.lastname: Collett
authors.affiliation: Liver Match Study, Associazione Italiana Studio Fegato (AISF), Rome, Italy.
authors.forename: Renato
authors.identifier: 0000-0001-8340-8885
authors.initials: R
authors.lastname: Romagnoli
authors.affiliation: Liver Match Study, Associazione Italiana Studio Fegato (AISF), Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinna
authors.affiliation: National Health Service Blood and Transplant (NHSBT), Bristol, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Gimson
authors.affiliation: National Health Service Blood and Transplant (NHSBT), Bristol, UK.
authors.forename: James M
authors.initials: JM
authors.lastname: Neuberger
authors.affiliation: Liver Match Study, Associazione Italiana Studio Fegato (AISF), Rome, Italy. angelico@med.uniroma2.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Angelico
mesh_terms: D000328:Adult; D000368:Aged; D019985:Benchmarking; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D015331:Cohort Studies; D016208:Databases, Factual; D046148:Donor Selection; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D015996:Survival Rate; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: international comparison; liver transplantation; survival