2014
DOI: 10.1136/gutjnl-2014-307263.34
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OC-034 Outcome Of Patients Considered Unsuitable For Liver Transplantation – A Missed Opportunity For Palliative Care?

Abstract: Introduction Patients with end stage liver disease (ESLD) and/or hepato-cellular carcinoma (HCC) may be considered unsuitable for liver transplantation (LT) due to disease severity at presentation or de-listed due to disease progression. These patients have complex medical needs and a limited life expectancy and would be expected to benefit from access to palliative care services. Methods We performed a retrospective audit of patients assessed for LT between 2010-12 at the Royal Free Hospital. We studied patie… Show more

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Cited by 3 publications
(4 citation statements)
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“…Three studies, from transplant units each retrospectively assessed the proportion of patients either delisted or assessed unsuitable for transplantation who were referred for SPC over a 12-month period. The UK study reported that 19% of patients were referred, on average 4 days before death16 with similar findings in Canada and the USA (box 1). 17 18…”
Section: Barriers To Good Palliative and Supportive Caresupporting
confidence: 63%
“…Three studies, from transplant units each retrospectively assessed the proportion of patients either delisted or assessed unsuitable for transplantation who were referred for SPC over a 12-month period. The UK study reported that 19% of patients were referred, on average 4 days before death16 with similar findings in Canada and the USA (box 1). 17 18…”
Section: Barriers To Good Palliative and Supportive Caresupporting
confidence: 63%
“…28 Palliative care services are seldom accessed by patients with non-malignant liver disease, with interventions typically limited to inpatient end-of-life care for a minority of patients. 11,12 Timely palliative care is cost effective and can curtail futile and expensive interventions at the end of life. 29 Whilst definitions of curability and utilisation of 'best supportive care' approaches are clearly embedded into international guidelines for the management of HCC, 30 prediction of irrevocable decline in non-malignant liver disease is arguably more difficult.…”
Section: Discussionmentioning
confidence: 99%
“…7 The need to improve end-of-life care for patients with liver disease has been recognised internationally. 9,10 Patients who are unsuitable for organ transplantation are unlikely to receive specialist palliative care; 11,12 and rates of death occurring in hospital (a proxy measure for quality of end-of-life care) are significantly higher in cirrhosis than for other conditions. In England, over two-thirds of deaths secondary to liver disease (over 80% for alcohol related liver disease -ArLD) occur in hospital, compared with under 40% for cancer.…”
Section: Introductionmentioning
confidence: 99%
“…Evidence from other UK centres however suggests that, in the absence of a predefined trigger, initiation of palliative and supportive care is rare 8. Routine referral would require a substantial culture change and clinicians may reasonably demand persuasive data to alter their practice.…”
Section: Discussionmentioning
confidence: 99%