Liver transplantation in patients with primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD)
In Europe, PSC is often associated to the presence of IBD and both disease influence reciprocally their pathophysiology. Additionally, an increased risk of colorectal and hepatobiliary malignancies in IBD and PSC respectively has been reported.
Although LT for PSC (+/- IBD) represents a standard indication, many questions remain unanswered, including:
- Pathophysiology, natural history and clinical aspects of PSC + IBD
- Surveillance strategies: focus on bile duct, liver and intestine
- Indication and timing of liver transplantation
- Management of bile duct stenosis on waiting list: diagnosis and treatment
- Technical aspects of liver transplantation
- Prophylaxis and management of recurrent of PSC and IBD
- Timing and extension of intestinal resection (e.g. colectomy)
The main aim of this topic is to discuss the above concepts and to reach a final consensus, which is urgently needed.
Topic Chairs: Luca Belli & Silvio Nadalin
Topic Steering Committee: Marco Carbone, Chiara Mazzarelli, Andrea Della Penna, Eleonora De Martin, Annika Bergquist, Pal Dag Line, James Neuberger, Palak Trivedi
Clinical endpoints in liver transplantation according to value based care
Current healthcare systems are still diffusely linked to a pay per procedure methodology. Such an approach is associated to a high risk to reduce the efficiency of the systems to achieve their value-based goals. That is particularly relevant in the context of limited resource environments as in transplantation.
The concept of ‘value-based healthcare’ (VBHC) has been recently proposed with the ambition to maximise outcomes achieved per resources spent. The implementation of VBHC is particularly relevant in organ transplantation, which represents a costly procedure offered to a minority of highly selected patients with end-stage organ disease. However, there is no agreed definition of what value means (for whom) in the health context in general and, in particular, in the transplantation area, including for survival and quality adjusted life years.
Topic Chairs: Umberto Cillo & Mario Strazzabosco
Topic Steering Committee: James Neuberger, Marco Carbone, Agostino Colli, Wojciech Polak, Constantino Fondevila, Anna Forsberg, Sandor Mihaly, Lorenzo Mantovani, Ian Rowe, Alessandra Nardi, Liz Schick, Karen Rockell
Downstaging, bridging and immunotherapy in liver transplantation for HCC
Over the past two decades, selection criteria to determine eligibility for liver transplantation have been constantly refined but a fair allocation strategy of liver grafts to HCC patients remains challenging. In Europe, over a dozen transplantation networks apply different liver transplantation criteria for HCC patients. Differences sometimes even appear within countries, opening the door to medical tourism and unnecessary competition between centres.
Our aim is to reach a consensus, and a better homogeneity between centres and networks. The main focus will be on downstaging, bridging and immunotherapy.
Topic chair: Christian Toso
Topic Steering Committee: Marco Claasen, Dimitri Sneiders, Gonzalo Sapisochin, Maria Reig, René Adam, Umberto Cillo, Parissa Tabrizian, Sherrie Bhoori, Constantino Fondevilla, Bastiaan Rakke