[Kidney transplantation in Italy: an evolving scenario]. / Il trapianto di rene in Italia: una realtà in evoluzione.

BACKGROUND: Italian transplantation systems have dramatically improved in the last decade. Kidney transplantations are now strictly monitored and excellent results has been achieved in terms of quality and the ability to reduce waiting times for receiving transplantation. METHODS: The Italian organizational retrieval and transplant system is articulated on four levels: local, regional, inter-regional and national. The Italian Transplant Information System (SIT) was set up in 2000 in accordance with Law 91/99. Patient data on the waiting lists and follow-up of transplanted patients are routinely collected. RESULTS: A total of 4406 kidney transplants have been carried out in the 40 Italian kidney transplant centers in 2001-2003. The survival analysis was conducted for the 2000-2002 in 4222 cases. Overall 1-yr survival was 92.4% for the graft and 97% for the patients. After adjusting for variables independently associated with the outcome at multivariate analysis (for example, the case-mix), patient and graft survival at 1 yr was 98.1% and 93.8%, respectively. No remarkable differences in 1-yr graft survival were observed between the 40 Italian kidney transplant centers. At multivariate analysis, variables independently associated with graft failure were donor age, degree of HLA mismatch and recipient case-mix. Analysis of the waiting list showed approximately 6500 patients waiting for kidney transplantation. The mean waiting time was 3.04 yrs, with a mortality rate of 1.18% per year. CONCLUSIONS: Kidney transplantation activity in Italy has produced excellent results in terms of quality and number of transplants per year. However, the number of patients on the waiting list and the waiting time call for further action to increase the number of available organs.

Quality evaluation of solid organ transplant in Italy for the period 2000 to 2002 data from the national transplant center.

BACKGROUND: As part of the increased need for transparency and disclosure of information in health care, the Italian Minister of Health has commissioned the Superior Institute of Health to study health outcomes for several procedures, among which is solid organ transplants. We herein report the results of a quality evaluation of solid organ transplants and on the relationship between hospital volume of activity and outcomes, using the data routinely collected by the National Transplant Center during the period 2000 to 2002. METHODS: We collected and analyzed all the information on solid organ transplants between 2000 and 2002, along with clinical information before and after transplant. Multivariate survival analysis was performed to adjust the follow-up data for the complexity of the cases. Correlation graphs are presented that assess the association between the number of transplants and the adjusted 1-year survival of both the organ and the patient. RESULTS: One-year survival was 92.4% for kidney, 77.8% for liver, and 83.9% for heart. Patient survival was 97.0%, 84.1%, and 83.9%, respectively. A negative correlation was observed between the number of transplants performed by each center and 1-year survival of the organ. CONCLUSIONS: Our study indicated that survival after organ transplants in Italy is good and that hospital quality, indirectly measured through survival, overlaps that observed in other Western countries.

A 5-year analysis of organ donors and recipients in Italy.

This article describes the improvement of organ donation and transplantation in Italy during 1995-1999. In 1999, the mean number of donors per million population reached 13.7 in Italy. In addition, an analysis regarding major characteristics of donors and recipients is presented, focusing particularly on donor characteristics that have changed in the past 5 years. Despite the encouraging results, further efforts are required to reach the European mean, which still remains higher than the Italian national mean. In particular, an increase of organ donation and procurement in regions with a poor activity in this field is crucial. A 1999 law on donation and transplantation should help in solving problems that continue to affect part of the nation, especially preparing the healthcare staff dedicated to organ retrieval to promote organ procurement.

[Statistical bases and models for the selection of kidney transplant recipients]. / Basi statistiche e modelli per la scelta del ricevente del trapianto renale.

The thesis of this study is that the use of discrete simulations is the most appropriate instrument to support the definition of a kidney allocation procedure. We first furnished a general description of what it means to run a simulation to solve the problems related to the study of the statistical characteristics of any population. In the second part of the paper we mathematically formalized the subject of our study: the statistical properties of waiting lists, allocation algorithm and transplants. The third part reported the results of several simulations we have done with the aim to show the potential of these methods at assessing the most appropriate adjustments for the optimization of any allocation scheme.

[The national program of pediatric transplantation]. / Il programma nazionale di trapianto pediatrico.

The national programme for paediatric transplants currently implemented at the Istituto Superiore di Sanità is one of the first results of the efforts devoted to the definition of an efficient co-ordination policy of the transplantation activity in Italy. Since 1997 the programme has allowed all transplant centres throughout Italy to share unified waiting lists for kidney, heart, lung and liver, which gives paediatric patients a much better possibility than with local waiting lists. We present the regulations, criteria and operative solutions adopted to make the programme work, and the analysis of the data collected in these three years. The analysis gives statistical information on the composition and evolution of waiting lists and transplants done, which may be useful in the continuous process of revision and improvement of the criteria for recipient selection.