Cecilia Pravadelli, Alberto Ferrarese, Luisa Moser, Francesco Paolo Russo, Giacomo Germani, Marco Senzolo, Martina Gambato, Alberto Zanetto, Sara Battistella, Elisa Menotti, Flora Agugiaro, Giovanni Vettori, Giovanni de Pretis, Pamela Ballotta, Ivana Maioli, Armando Gabbrielli, Lucia Pilati, Tiziano Martello, Umberto Cillo, Patrizia Burra
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引用次数: 0
Abstract
Liver transplantation (LT) represents an effective therapeutic option for patients with end-stage liver disease and hepatocellular carcinoma. However, barriers to access LT programs still exist for many patients, including distance from transplant centers and delays in referral. Furthermore, long-term care is required also in stable LT recipients. This pilot study aims to evaluate the characteristics and outcomes of patients with end-stage liver disease referred to Padua University Hospital following the implementation of a structured referral program with Trento Hospital. Furthermore, the study assesses the outcomes of LT recipients who were referred back and continued follow-up care at the Spoke Center. After an internal work reorganization at the Spoke Center to improve care for patients with liver disease, we designed this prospective pilot study based on a structured referral and referral-back program for managing patients before and after LT. Accordingly, all inpatients potentially eligible for LT were transferred from the Gastroenterology Unit at Trento Hospital to the Multivisceral Transplant Unit at Padua University Hospital between 2020-2023. Similarly, stable LT recipients were referred back to the Spoke Center for management of long-term follow-up. During the study period, 27 adult inpatients (59% male; median age 50 [42-51] years) deemed eligible for LT were consecutively referred from Trento to Padua. The median [IQR] MELD score at the time of referral was 26 [23-30], and the length of stay at the LT Center was 21 [18-23] days. At the end of follow-up, 6 (22%) patients underwent LT, while the transplant-free survival rate was 37%. During the same period, 27 stable adult LT recipients (55% male; median age at referral back 56 years; median time since LT 9 years) living near Trento were referred back to the Spoke Center. During the follow-up, n.19 (70%) patients experienced at least one medical complication (40% liver-related), the majority of these being managed at the Spoke Center. LT recipient satisfaction of this way of care Center was high. A structured Hub and Spoke collaboration increase access to LT, making it more equitable, and improves the management of stable LT recipients closer to home.
尽早:Hub and Spoke转诊和转诊回诊试点项目增加了获得肝移植的机会,并确保良好的长期护理。
肝移植(LT)是终末期肝病和肝细胞癌患者的有效治疗选择。然而,对于许多患者来说,进入移植项目的障碍仍然存在,包括距离移植中心的距离和转诊的延迟。此外,稳定的肾移植受者也需要长期护理。本试点研究旨在评估在特伦托医院实施结构化转诊计划后转诊到帕多瓦大学医院的终末期肝病患者的特征和结果。此外,该研究评估了在Spoke中心转介并继续随访治疗的LT接受者的结果。在Spoke中心进行内部工作重组以改善肝病患者的护理后,我们设计了这项前瞻性试点研究,该研究基于结构化的转诊和转诊回计划,用于管理移植前后的患者。因此,所有可能符合移植条件的住院患者在2020-2023年间从Trento医院的胃肠病学部门转移到帕多瓦大学医院的多内脏移植部门。同样,稳定的肝移植受者被转回Spoke中心进行长期随访。在研究期间,27名成年住院患者(59%为男性;中位年龄50[42-51]岁)被认为符合肝移植条件的患者依次从Trento转至Padua。转诊时的中位[IQR] MELD评分为26[23-30],在LT中心的住院时间为21[18-23]天。随访结束时,6例(22%)患者接受了肝移植,无移植生存率为37%。在同一时期,27名稳定的成年肝移植受体(55%为男性;复诊时的中位年龄56岁;居住在特伦托附近的中位数时间为9年,被转介回Spoke中心。在随访期间,n.19(70%)患者经历了至少一种医学并发症(40%与肝脏有关),其中大多数在Spoke中心进行治疗。接受者对这种护理方式的满意度较高。结构化的Hub and Spoke协作增加了对LT的获取,使其更加公平,并改善了对离家更近的稳定LT接受者的管理。
期刊介绍:
Updates in Surgery (UPIS) has been founded in 2010 as the official journal of the Italian Society of Surgery. It’s an international, English-language, peer-reviewed journal dedicated to the surgical sciences. Its main goal is to offer a valuable update on the most recent developments of those surgical techniques that are rapidly evolving, forcing the community of surgeons to a rigorous debate and a continuous refinement of standards of care. In this respect position papers on the mostly debated surgical approaches and accreditation criteria have been published and are welcome for the future.
Beside its focus on general surgery, the journal draws particular attention to cutting edge topics and emerging surgical fields that are publishing in monothematic issues guest edited by well-known experts.
Updates in Surgery has been considering various types of papers: editorials, comprehensive reviews, original studies and technical notes related to specific surgical procedures and techniques on liver, colorectal, gastric, pancreatic, robotic and bariatric surgery.