{
  "abstract": "Outcome variability in liver transplantation remains globally driven by differences in donor-recipient characteristics and in risk-mitigation strategies. Prediction models lack geographic balance and fail to account for current disease classification and advanced organ preservation methods. The IMPROVEMENT study (ClinicalTrials.gov, NCT05289609) aimed to characterise the donor-recipient risks and to develop and validate global prognostic algorithms (mortality and complication rate). This non-competitive, international, cohort study involved 61 centres across Europe, Asia, North and South America, Oceania. Centres provided 83 balanced data series. 5218 patients were enroled in retrospective (2017-2019) and/or prospective (2022-2023) cohorts to avoid COVID-19 confounding. A four-step analytical hierarchy process (world maps, radar graphs, donor versus recipient risk plot, and mixed-effects generalised models) enables visualisation of risk propensity, namely, \"aggressiveness\", and risk-mitigation balance, namely \"coverage adequacy\". Outcome measures were 90-, 365-, and 730-day mortality and high complication rates. Overall survival rates at 90 days, 1 year and 5 years were 93, 90 and 80, respectively. Predictors of mortality included recipient age, CAD, pre-operative complex portal thrombosis, preoperative ventilatory life support, MASLD, MELD 3.0 > 30, packed red blood transfusions (PRBC), and cold ischaemia time ≥360 min. The high complication rate resulted dependent from preoperative ventilatory life support, complex portal thrombosis, TIPS and PRBC. Notably, donor factors had a low impact on outcomes, reflecting successful donor-recipient matching and new graft perfusion modalities. Transplant at high-volume centres (>65 transplants/year) was a significant protective factor (mortality and complication rates). C-statistics of 90-day mortality and high complication rate models were 0.78 and 0.77, respectively. The IMPROVEMENT study shows that, unlike before, recipient and system-level factors now appear to account for the largest proportion of outcome variability. Implementing risk-mitigation strategies can offset high-risk profiles. These findings provide a robust framework for equitable health resource allocation and clinical decision-making worldwide. Italian Ministry of Health #RF-2021-12372422 grant.",
  "abstract_shown": true,
  "affiliations": [
    "General Surgery and Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.",
    "Università Cattolica del Sacro Cuore, Rome, Italy.",
    "General Surgery and Organ Transplantation Unit, Department of General and Specialist Surgery and Anesthesiology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.",
    "Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.",
    "Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy & General Surgery and Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy.",
    "MAYO Clinic, Jacksonville, FL, USA.",
    "Cirugía Hepato-Bilio-Pancreática, Transplante Hepático, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.",
    "Hamamatsu Rosai Hospital, Shogen-cho, Chuoku, Hamamatsu, Shizuoka, Japan.",
    "Hepatobiliary Surgery and Liver Transplantation Unit, Cruces University Hospital, University of the Basque Country, Biobizkaia Health Research Institute, Bilbao, Spain.",
    "Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.",
    "Transplant Division, Department of Surgery, University of Massachusetts, Worcester, MA, USA.",
    "Division of Transplantation Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.",
    "Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, University MC Rotterdam, Rotterdam, the Netherlands.",
    "Department of Liver Transplantation, Cleveland Clinic, Cleveland, OH, USA.",
    "Dr. Rela Institute & Medical Centre, Chennai, India.",
    "Multiorgan Transplantation, Toronto General Hospital, Toronto, Canada.",
    "Liver Transplant Division, Hospital Santa Isabel, Blumenau, Brazil.",
    "Federal University of Parana, Blumenau, Brazil.",
    "Liver Transplant Unit Department of Medicine University of Udine, ASUFC-Udine, Italy.",
    "Department of Surgery and Transplantation, Bahcesehir University School of Medicine, Medical Park Goztepe Hospital, Istanbul, Turkey.",
    "New Zealand Liver Transplant Unit - Te Toka Tumai, Auckland City Hospital, Auckland, New Zealand.",
    "Liver Transplantation Unit, University of Campinas-UNICAMP, San Paolo, Brazil.",
    "Department of General, Visceral-, Abdominal-, Transplantation and Pediatric Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany.",
    "Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano - SC Chirurgia Generale e Trapianti di Fegato, Milan, Italy.",
    "Liver Transplant Unit, University Hospital Trust of Verona, Verona, Italy.",
    "Hepatobiliary Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy & Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.",
    "Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.",
    "Service de Chirurgie et Transplantation Abdominale, Cliniques Universitaires Saint-Luc, Louvain, Belgium.",
    "General Surgery and Abdominal Transplantation Unit, University of Milano-Bicocca and Niguarda-CàGranda Hospital, Milan, Italy.",
    "Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.",
    "Division of Transplant Surgery, Department of Surgery, Indiana University, Indianapolis, IN, USA.",
    "Division of Transplant Surgery, Department of Surgery, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA.",
    "Department of General Surgery and Transplantation Unit, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.",
    "Department of Hepatopancreatic Surgery, First People's Hospital of Foshan, Foshan, China.",
    "Division of Hepatic Surgery and Liver Transplantation, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.",
    "Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.",
    "IRCCS ISMETT, Palermo, Italy & Department of General Surgery and Medical-Surgical Specialities, Catania, Italy.",
    "Department of Liver Transplant and HPB Surgeries, Max Super Speciality Hospital, Saket, New Delhi, India.",
    "HPB and Transplant Surgery, Newcastle Hospital NHS Foundation Trust, Newcastle, UK.",
    "General Surgery 1, Zhongshan People's Hospital, Zhongshan, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 153,
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  "bibtex": "https://research.draconitic.com/paper/33ksyh671yeet.bib",
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  "doi": "10.1016/j.lanepe.2026.101889",
  "fulltext_url": "https://europepmc.org/articles/PMC13743410",
  "id": "33ksyh671yeet",
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  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
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  "pdf_url": "https://europepmc.org/articles/PMC13743410?pdf=render",
  "pmcid": "PMC13743410",
  "pmid": "42999582",
  "published": "2026-10-29",
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  "title": "Regional and national variation in donor and recipient characteristics, transplant practice, and outcomes after liver transplantation (the IMPROVEMENT collaborative): a multicentre cohort study.",
  "title_text": "Regional and national variation in donor and recipient characteristics, transplant practice, and outcomes after liver transplantation (the IMPROVEMENT collaborative): a multicentre cohort study.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:34Z",
  "url": "https://research.draconitic.com/paper/33ksyh671yeet",
  "venue": "The Lancet regional health. Europe",
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