Implementation of a Regional Liver Transplant Network: The Tuscany Experience

Abstract

Background and Aims

The liver transplant scenario has significantly changed during the last decade due to the expansion of transplant indications and the increased availability of donor organs. In Tuscany, the number of liver transplants at the referral center in Pisa has increased significantly to 176 in 2024. For these reasons, the Tuscany Transplantation Organization (O.T.T.) has appointed a regional commission with the priority goal of implementing the network of health professionals connected to the pathway of patients with indication for liver transplantation to optimize the allocation of organs, with particular regard to the satisfaction of regional needs, and working on the timing and appropriateness of transplant indications. This project has been implemented over the past year to achieve a more comprehensive pre-transplant patient referral and evaluation and to optimize care for patients who have already undergone transplantation.

Methods

The primary objective of this first year of work was, therefore, to verify the feasibility of establishing and implementing a territorial network for the referral and referral-back of Tuscan patients with terminal liver failure or liver neoplasms susceptible to organ replacement treatment (Transplant Oncology). A series of eight meetings was held, gathering representatives from the Tuscan divisions of Hepatology, Infectious Diseases, Gastroenterology, and Internal Medicine, and promoting specific training sessions on the following topics: pre-transplantation, post-transplantation, and transplant oncology. Additionally, three specific training courses were organized for nurses and physicians from the three major geographical areas of Tuscany. A pivotal element was the implementation of collaboration with the Association of Tuscan Hepatologists (ET), which involved planning and producing 15 short videos on indications for liver transplantation and communication with the transplant center. The goal is to disseminate informative and scientific material on the organization's institutional website, facilitating widespread distribution with a special focus on young professionals. Finally, a specific course involving General Practitioners (GPs) has been scheduled.

Results

A first census of the territorial hospital divisions active in the transplantation pathway (pre- and post-phase or both) and of the living Tuscan patients was conducted, with a survey of more than 1,000 patients already in charge as of July 31, 2024. Data from the Tuscan Liver Transplant Network for the second half of 2024 show an increase in the number of patients proposed, with stable data on the proportion of regional transplant recipients (60%) and those from outside the region (40%). In 2024, 344 first liver transplant visits were performed: 250 from Tuscany (73%), of these, 107 patients were transplanted out of a total of 176 transplants (61%). In January 2025, funding was approved by O.T.T. for projects for the biennium 2025/2026 submitted by some hospital divisions affiliated with the Tuscan liver transplant network.

Conclusions

We have reported the methods and initial results of the regional Tuscan Liver Transplant Network designed to facilitate efficient communication and coordination among the territorial reference centers, the transplant center, and regional authorities. A structured and well-recognized territorial network enables the appropriate identification and referral of patients eligible for the transplant pathway. After transplantation, it facilitates the continuation of care and surveillance for possible complications, following unambiguous and shared protocols at facilities closer to the patients' residences, thereby reducing travel and optimizing available resources, with shorter waiting times.