The IMPROVEMENT project: first report of the global liver transplant activity

Methods Three LT types are included according to the donor: standard Deceased Brain Donors (DBDs); Deceased Cardiac Donors (DCDs); high-risk DBDs; Living donors (LDs). The data collection (retrospective/completed or prospective/ongoing includes [high volume (>65 LTs/yr) and intermediate-volume (≤65 LTs/yr)]. Each Center enrolled a fixed number of LT to minimize Center-volume bias. Results The retrospective data consists of 3,884 LT from 2017 to 2019. There were 2958 (76.2%) standard DBDs, 797 (20.5%) DCD & amp; high-risk DBDs, 129 (3.3%) LDs. We stratified the cases into 5 geographical areas (Fig. 1A): Italy (N=1,766); Europe except-Italy (N=936); Asia-Oceania (N=496); North-America (N=377); South-America (N=309). Among the 53 LT centers of the retrospective cohort, there were 27 high-volume centers and 26 intermediate-volume centers). Italy and Asia had the larger adoption of machine perfusion, while DCDs were prevalent in Europe and North-America. Extended Criteria Donors (ECD) were mainly performed in Italy and North-America. Italy shows the highest donor age followed by Europe except Italy, North-America, South-America and Asia-Oceania. The mean recipient age was similar in all the areas, with a prevalence of hepatocarcinoma in Italy (Fig. 1B). The differences in the prevalence of other indications are summarised (Fig. 1C). Conclusions The analysis of IMPROVEMENT data depicts a screenshot of global liver transplant activity, never done before. Differences are due to epidemiological and logistic factors. The prospective data (ongoing) will provide more accurate information.