PTU-087 Specialist MDT clinic management improves acceptance rates and post-transplant relapse in patients with ArLD

Ding, Michael Q.; Parker, Charlotte; Towey, Jennifer; Harborne, Matthew; Ngonadi, Chiemelie; Magrabi, Malik; Hopkins, Laurence; Mohideen, Anya; Harrison, Abbie; Catling, Jonathan; Rajoriya, Neil; Holt, Andrew

doi:10.1136/gutjnl-2019-bsgabstracts.446

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“…The patients were entered into a formal alcohol liver transplant MDT clinic engaging in modification and amelioration of their alcohol risk behaviour through work with the MDT team as recommended in current UK guidelines. 12 While there are ethical and financial considerations towards repeating LT assessments in all patients who have been declined LT at one unit due to alcohol risk, we have shown that significant improvements can occur in some patients with allowing them access towards LT. 13 In the outgoing cohort, 3/8 STCOs (indications: ArLD, chronic liver graft rejection and NASH) were patient driven. Of these, only one was added on the waiting list and transplanted (indication: NASH).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of incoming and outgoing second opinions from a UK liver transplant centre

Parente

Boyd

Mahgoub

et al. 2022

BMJ Open Gastroenterol

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ObjectiveSecond transplant centre opinions (STCOs) for patients declined for liver transplantation are infrequent. We aimed to identify STCOs outcomes from a tertiary transplant centre.DesignReferrals between 2012 and 2020 to Birmingham Unit were reviewed. Incoming: all referrals from out-of-region centres were collated. Outgoing: patients not listed in Birmingham were reviewed to identify referrals for STCOs to the other UK centres (A–F).Results2535 patients were assessed for liver transplantation during the study period. Incoming: among 1751 referrals, 23 STCOs (17 unit A, 3 unit B, 1 unit C, 1 unit D and 1 unit E) were provided by Birmingham. Of the STCOs, 13/23 (57%) patients remained unsuitable for transplantation. Therefore, 10/23 (43%) underwent a second liver transplant assessment, of whom five (50%) were still deemed unsuitable, three (30%) listed (one transplanted) and two (20%) died preassessment. Outgoing: among 426 patients not listed, eight (1.8%) patients were referred for STCO (4 unit E, 2 unit B, 1 unit D, 1 unit A). Three (38%) were listed, two (25%) were assessed and declined, two (25%) were unsuitable for assessment and one (12.5%) died while waiting. Combining incoming and outgoing Birmingham STCOs (n=31), six (19%) of STCOs were listed in a second centre.ConclusionSecond transplant centre opinions are rare with the majority still deemed unsuitable for liver transplantation. This highlights potential resource implications especially when undergoing a full second formal assessment. A streamlined STCO process with sharing of investigations and use of telemedicine in appropriate patients may allow for greater transparency, quicker decision making and less use of labour-intensive resources.

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Section: Discussionmentioning

confidence: 99%