Introduction UK liver transplant centres frequently link with other tertiary liver centres to improve access for patient and secure a broader referral base, and is consistent with a “hub-and-spoke model” for liver services. Our aim is to evaluate outcomes from the Nottingham-Cambridge transplantation service.
Method Nottingham-Cambridge outreach liver transplant service was established in 2010. We recorded demographics, disease aetiology, indication, time of referral and listing, UKELD, complications and 3-year survival following transplantation. Outcomes were compared to historical controls of published data from Addenbrooke’s transplant service.
Results 106 patients were reviewed between 2010–2014. 18 patients (16.9%) received transplant at Addenbrooke’s prior to 2010, 88 (83%) were considered for transplant after 2010.
There were 50 males (mean age 52 +/- 12.4 SD years) and 38 females (mean age 52.3 +/- 12.3 SD years). Aetiologies were alcoholic liver disease n = 30 (34%), hepatitis C n = 18 (20.5%), hepatitis B n = 4 (4.5%), autoimmune including PBC and PSC n = 15 (17%), metabolic n = 11 (12.5%), cryptogenic cirrhosis n = 4 (4.5%), paracetamol overdose n = 2 (2.2%) and biliary atresia, familial intrahepatic cholestasis, erythrohepatic porphyria and polycystic liver kidney disease each of n = 1 (1.1%).
Chronic liver disease remains the main indication for transplant n = 73 (83%), acute liver failure and hepatocellular carcinoma each contributed to n = 6 (6.8%), graft failure of n = 3 (3.4%). Average time from referral to listing for transplant was 90 days and mean UKELD is 55.
42/88 (47.7%) received transplant, 9/88 (10.2%) patients are currently listed, 21/88 (23.8%) patients were deferred, 4 (4.5%) suspended once listed, 6 (6.8%) failed assessment for transplant, 1 undergoing assessment, 3 died while on waiting list and 2 died before assessment.
Average time after listing to receive transplant was 136 days, compared to historical control of 135 days (95% CI 100–170; p=ns). 90-day graft and patient survivals were 97.6% and 95.2% compared to 93.5% (95% CI 84–96.6%; p=ns) and 95.1% (95% CI 86.1–98.7%; p=ns).
Complications occurred in 16/42 transplanted; 2 deaths (4.8%), 4 (9.5%) anastomotic biliary strictures, 2 (13.3%) cholestatic hepatitis C, 2 (4.8%) depression and one each (2.4%) of hepatic artery thrombosis, splenic artery aneurysm, PRES-associated seizures, atypical cellular injury, recidivism and ongoing hepato-pulmonary syndrome.
Conclusion The Nottingham-Cambridge satellite service has waiting times, survival outcomes comparable to Addenbrooke’s transplant unit outcomes and this support the extension of such collaboration throughout the UK. This requires close collaboration between clinical teams.
Disclosure of interest None Declared.
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