Liver transplantation for alcohol-related liver disease in the UK: revised UK Liver Advisory Group recommendations for referral

Masson, Steven; Aldersley, Helen; Leithead, Joanna A.; Day, Ed; Langford, Andrew; Healy, Pamela; O’Grady, John; Thorburn, Douglas; Parker, Charlotte; Shepherd, Liz; Arndtz, Katherine; Webb, Kerry; Holt, Andrew

doi:10.1016/s2468-1253(21)00195-3

Cited by 11 publications

(13 citation statements)

References 70 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The few exceptions that prove the rule Except for some countries such as the United Kingdom 16,17 or Denmark, 18 or cities where there is a strong tradition of social epidemiology research such as Barcelona 19,20 or Rotterdam, 21 it appears that Europe as a whole is overlooking the investigation of health inequality in liver disease. In addition, most studies are conducted by general epidemiologists who are not specifically devoted to liver disease analysis, while adopting an equity lens is a rarity amongst clinicians, i.e.…”

Section: Potential Reasons Why Europe Is Lagging In the Study Of Heal...mentioning

confidence: 99%

Applying an equity lens to liver health and research in Europe

Ventura‐Cots¹,

Bataller²,

Lazarus³

et al. 2022

Journal of Hepatology

View full text Add to dashboard Cite

Section: Potential Reasons Why Europe Is Lagging In the Study Of Heal...mentioning

confidence: 99%

Applying an equity lens to liver health and research in Europe

Ventura‐Cots¹,

Bataller²,

Lazarus³

et al. 2022

Journal of Hepatology

View full text Add to dashboard Cite

“…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: 79%

“…Of these patients added, the LT indication was ArLD, and the reason for turning down from the first transplant centre was high risk of alcohol relapse/recidivism in all three cases. 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.…”

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…The landscape of public and medical opinion on offering transplantation for SAH is changing in light of this data. However, concerns remain that predictive models are suboptimal and over 50% of patients with an unfavourable prognosis based on the Lille Score will survive without LT 37. As such, the UK pilot on LT in SAH failed to recruit any patients over a 3-year period and was closed 38.…”

Section: Case Partmentioning

confidence: 99%

“…As such, the UK pilot on LT in SAH failed to recruit any patients over a 3-year period and was closed 38. The current UK position recommends that if liver insufficiency persists after 3 months of documented alcohol abstinence in individuals with an index presentation of severe AH, consideration should be given to referral for liver transplantation if their psychosocial risk profile is favourable 37…”

Section: Case Partmentioning

confidence: 99%