Regional and national variation in donor and recipient characteristics, transplant practice, and outcomes after liver transplantation (the IMPROVEMENT collaborative): a multicentre cohort study.

@article{avolio2026regional,
  title = {{Regional and national variation in donor and recipient characteristics, transplant practice, and outcomes after liver transplantation (the IMPROVEMENT collaborative): a multicentre cohort study.}},
  author = {Alfonso W Avolio and Marco M Pascale and Quirino Lai and Patrizia Burra and Umberto Cillo and Kristopher P Croome and Martin De Santibanes and Hiroto Egawa and Mikel M Gastaca and Zhiyong Guo and Paulo N Martins and Gabriel C Oniscu and Wojciech G Polak and Cristiano Quintini and Mohamed Rela and Gonzalo Sapisochin and Julio C Wiederkehr and Umberto Baccarani and Deniz Balci and Louise A Barbier and Ilka de Fatima Santana Ferreira Boin and Felix Braun and Lucio Caccamo and Amedeo Carraro and Matteo Cescon and Zhishui Chen and Olga Ciccarelli and Luciano G De Carlis and Fabrizio Di Benedetto and Burcin Ekser and Giuseppe M Ettorre and Deng Feiwen and Davide Ghinolfi and Michal J Grat and Salvatore Gruttadauria and Subhash Gupta and John Hammond and Xiaoshun He and Zemin Hu and Takashi Ito and Sunhawit Junrungsee and Mickael Lesurtel and Laura Llado and Jean Y Mabrut and Daniel Maluf and Vincenzo Mazzaferro and Gilberto A Mejia and Artem Monakhov and Silvio Nadalin and Brian M Nguyen and Nghia Q Nguyen and Bunthoon Noonthasoot and Madhukar S Patel and Thamara Perera and Marcos V Perini and Domenico Pinelli and Carlo Pulitano and Renato Romagnoli and Massimo Rossi and Ephrem Salame},
  journal = {The Lancet regional health. Europe},
  year = {2026},
  month = oct,
  doi = {10.1016/j.lanepe.2026.101889},
  url = {https://europepmc.org/article/MED/42999582},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - Regional and national variation in donor and recipient characteristics, transplant practice, and outcomes after liver transplantation (the IMPROVEMENT collaborative): a multicentre cohort study.
AU  - Alfonso W Avolio
AU  - Marco M Pascale
AU  - Quirino Lai
AU  - Patrizia Burra
AU  - Umberto Cillo
AU  - Kristopher P Croome
AU  - Martin De Santibanes
AU  - Hiroto Egawa
AU  - Mikel M Gastaca
AU  - Zhiyong Guo
AU  - Paulo N Martins
AU  - Gabriel C Oniscu
AU  - Wojciech G Polak
AU  - Cristiano Quintini
AU  - Mohamed Rela
AU  - Gonzalo Sapisochin
AU  - Julio C Wiederkehr
AU  - Umberto Baccarani
AU  - Deniz Balci
AU  - Louise A Barbier
AU  - Ilka de Fatima Santana Ferreira Boin
AU  - Felix Braun
AU  - Lucio Caccamo
AU  - Amedeo Carraro
AU  - Matteo Cescon
AU  - Zhishui Chen
AU  - Olga Ciccarelli
AU  - Luciano G De Carlis
AU  - Fabrizio Di Benedetto
AU  - Burcin Ekser
AU  - Giuseppe M Ettorre
AU  - Deng Feiwen
AU  - Davide Ghinolfi
AU  - Michal J Grat
AU  - Salvatore Gruttadauria
AU  - Subhash Gupta
AU  - John Hammond
AU  - Xiaoshun He
AU  - Zemin Hu
AU  - Takashi Ito
AU  - Sunhawit Junrungsee
AU  - Mickael Lesurtel
AU  - Laura Llado
AU  - Jean Y Mabrut
AU  - Daniel Maluf
AU  - Vincenzo Mazzaferro
AU  - Gilberto A Mejia
AU  - Artem Monakhov
AU  - Silvio Nadalin
AU  - Brian M Nguyen
AU  - Nghia Q Nguyen
AU  - Bunthoon Noonthasoot
AU  - Madhukar S Patel
AU  - Thamara Perera
AU  - Marcos V Perini
AU  - Domenico Pinelli
AU  - Carlo Pulitano
AU  - Renato Romagnoli
AU  - Massimo Rossi
AU  - Ephrem Salame
PY  - 2026
DA  - 2026/10/29
JO  - The Lancet regional health. Europe
DO  - 10.1016/j.lanepe.2026.101889
UR  - https://europepmc.org/article/MED/42999582
AB  - 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.
SN  - 2666-7762
ER  -