International comparison of liver transplant programmes: differences in indications, donor and recipient selection and outcome between Italy and UK

Liver Int. 2016 Oct;36(10):1481-9. doi: 10.1111/liv.13132. Epub 2016 May 4.


Background & aims: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: international comparison; liver transplantation; survival.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Benchmarking
  • Carcinoma, Hepatocellular / surgery*
  • Cohort Studies
  • Databases, Factual
  • Donor Selection*
  • Female
  • Graft Rejection / epidemiology
  • Hepatitis C / surgery*
  • Humans
  • Italy / epidemiology
  • Kaplan-Meier Estimate
  • Liver Neoplasms / surgery*
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Regression Analysis
  • Survival Rate
  • United Kingdom / epidemiology
  • Young Adult