Risk-adjusted survival in liver transplant patients assessed and managed by a non-transplanting centre: South West Liver Unit experience

Abstract

BackgroundLiver transplant services remain a scarce resource not reflective of geography or burden of liver disease within the UK. To address geographical concerns in the South West (SW), a devolved network model of care for liver transplantation was established in 2004 between the SW Liver Unit (SWLU) at Derriford Hospital, Plymouth and King’s College Hospital, London. The SWLU has evolved to deliver both pre-transplant and post-transplant care for patients across the SW Peninsula. We determined whether risk-adjusted survival in patients assessed and managed at the SWLU compared with existing UK transplant centres.DesignRetrospective analysis of records at National Health Service Blood and Transplant (NHSBT) for patients ≥18 years listed or undergoing first liver only deceased donor transplantation from 1 January 2006 to 31 December 2017. Data collected and used were in accordance with standard NHSBT outcome measures.ResultsWe identified 8492 patients registered for first liver only transplant and 6140 patients who subsequently underwent transplantation. Of these, 215 patients listed and 172 patients transplanted were registered at the SWLU. The 1-year, 5-year and 10-year risk-adjusted post-listing survival for patients registered at the SWLU were 86%, 75% and 67%, respectively, with 1-year and 5-year risk-adjusted post-transplant survival 94.9% and 84.4%, respectively.ConclusionsRisk-adjusted post-listing 1-year, 5-year and 10-year survival outcomes and risk-adjusted 1-year and 5-year post-transplant survival outcomes at the SWLU are good and comparable with the seven UK transplant centres. These outcomes provide assurance that care delivered by our regional programme is equivalent to well-established liver transplant programmes.

Long-term outcomes of liver transplant recipients followed up in non-transplant centres: Care closer to home

“…Outcomes in non-transplant centres patient care close to home without compromising patient wellbeing. 24,25 Video-conferencing technology has already been successfully used to increase access to care in underserved areas in Canada, most notably in the treatment of hepatitis C infection and is increasingly used in the management of transplant recipients in non-transplant centres. Further, outreach clinics are becoming part of day-to-day clinical service provision.…”

Virtual liver transplant assessment: a novel pathway that is likely safe, effective and optimises access to transplantation

“…Given the negative impact of distance from transplant centre on patient outcomes, 1 2 King's College Hospital (KCH) developed a network of satellite liver transplant centres (SLTCs) in Plymouth and Belfast to optimise access to LT. 3 These centres deliver transplant assessment and comparable post-LT care to conventional LT centres. 4 However, patients are still required to complete their assessments at KCH prior to listing.…”

Satellite liver transplant centres significantly improve transplant assessment outcomes for patients with chronic liver disease but not hepatocellular carcinoma: a retrospective cohort study

“…However, the decision to accept a candidate for transplantation remains with the LT hub. SLTCs have been demonstrated to provide comparable outcomes to conventional LT centres for patients post-LT 10. A small study previously demonstrated that patients at SLTCs were more likely to be accepted as transplant candidates when referred for LT 11.…”