title: Risk Avoidance and Liver Transplantation: A Single-center Experience in a National Network.
abstract: OBJECTIVE
  To evaluate the risk avoidance policy at liver transplant centers.
  
  
  BACKGROUND
  Transplant center improvements have extended the indications for the sickest patients and the use of extended criteria donors (ECD). This may result in lower survival, perhaps paradoxically discouraging transplant centers from these procedures. We evaluated the outcome of recipients or donors refused by other transplant centers and transplanted by our transplant unit without risk avoidance policy.
  
  
  METHODS
  Between 2007 and 2015, 616 patients underwent liver transplantation at our Unit; 142 patients (23%) had been rejected by other Italian centers, because of recipient selection (70 patients, 11%) or because of donor selection (78 patients, 12%), group A. Recipient and donor features were analyzed and compared with 474 patients transplanted in the same period, group B.
  
  
  RESULTS
  Recipients were mainly rejected for comorbidity (19%), portal vein thrombosis (16%), previous surgery (9%), obesity (9%), and hepatocellular carcinoma (6%). Donors were rejected for HBcAb+ (33%), HCV+ (18%), liver biopsy (9%), HBsAg+ (6%), neoplastic (6%), or infective risk (5%).Most recipient and donor features were comparable between groups A and B.The 1- and 3-year overall graft and patient survival rates were similar in groups A and B and were comparable with national data.
  
  
  CONCLUSIONS
  Recipients and donor grafts were rejected for reasons not accepted by scientific literature. They did not differ from control group patients and their postoperative outcome was comparable. These results highlight the discrepancy among transplant centers and the relevance of risk avoidance in LT policy.
authors.affiliation: General Surgery and Transplant Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Gennaro
authors.initials: G
authors.lastname: Grande
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Gioia
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Massimo
authors.initials: M
authors.lastname: Del Gaudio
authors.forename: Cristina
authors.initials: C
authors.lastname: Morelli
authors.forename: Antonio D
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D007558:Italy; D008107:Liver Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012306:Risk; D015996:Survival Rate; D016896:Treatment Outcome