Article Text
Abstract
Survival rates for patients following liver transplantation exceed 90% at 12 months and approach 70% at 10 years. Part 1 of this guideline has dealt with all aspects of liver transplantation up to the point of placement on the waiting list. Part 2 explains the organ allocation process, organ donation and organ type and how this influences the choice of recipient. After organ allocation, the transplant surgery and the critical early post-operative period are, of necessity, confined to the liver transplant unit. However, patients will eventually return to their referring secondary care centre with a requirement for ongoing supervision. Part 2 of this guideline concerns three key areas of post liver transplantation care for the non-transplant specialist: (1) overseeing immunosuppression, including interactions and adherence; (2) the transplanted organ and how to initiate investigation of organ dysfunction; and (3) careful oversight of other organ systems, including optimising renal function, cardiovascular health and the psychosocial impact. The crucial significance of this holistic approach becomes more obvious as time passes from the transplant, when patients should expect the responsibility for managing the increasing number of non-liver consequences to lie with primary and secondary care.
- liver transplantation
- guideline
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Contributors There were 20 authors involved in the production of these two articles concerning liver transplantation. The original project was divided into an Introduction, nine sections and a Conclusion. From that original outline, the sections were written by writing groups and then collated. The nine sections were then divided into two halves for the purposes of publication, after discussion with the editor of Frontline Gastroenterology. Each contributor provided editing input to the project, as the manuscript went through its many iterations. The specific contribution/participation of each contributor are as follows: CM (consultant hepatologist in a DGH): senior author; initiated section divisions, collected manuscripts; contributed to writing by adding DGH aspects to all part 1 and management of the post-transplant patient section; edited all tables and oversaw the process; responsible for the overall content as guarantor. AC: consultant pharmacist; cowrote the section on immunosuppression agents in part 2 with JN and gave input to part 1, particularly with the ‘disease-specific considerations’ and where medication interactions can occur. MEC: consultant transplant hepatologist; coauthored the section on 'management of the patient on the waiting list' and then read both parts 1 and 2 of the final submission as an additional critique for all sections; critical role in the planning and acquisition of data for inclusion into the guideline, along with evaluation of relevance to the project; final manuscript editing and approval. AH: consultant transplant hepatologist; coauthored the section on 'how to refer' and then drew up the tables and added valuable additional input, as well as rewrote participation for the sections when the original submission was too lengthy; critical role in planning, final manuscript editing and approval. SH: consultant histopathologist; wrote the section on cellular rejection in part 2; added valuable oversight in part 1, particularly as both parts were too lengthy and required significant reduction in word count. JH: consultant hepatologist in a DGH; wrote the section on transplant assessment and with KJ refined this section to focus on the DGH referrer, and also read both completed parts to provide the DGH perspective on these elements of liver transplantation and ensure focus was correct for that audience; critical role in planning and acquisition of data for inclusion into part 1 of the guideline, along with an evaluation of relevance to the project; editing and approval of parts 1 and 2 of the final manuscript. KJ: transplant coordinator; provided the section on the transplant coordinator and then gave critical input for aspects on process of organ selection, along with RP; critical role in the planning and acquisition of data for inclusion in the guideline, along with evaluation of relevance to the project; final manuscript editing and approval. JL: consultant transplant hepatologist; coauthored the section on 'how to refer' and provided editorial input for part 2; critical role in the planning and acquisition of data for inclusion in the guideline, along with evaluation of relevance to the project; final manuscript editing and approval. SM: consultant transplant hepatologist; coauthored the section on 'how to manage the patient on the waiting list'; brought together the coordinators' input with the transplant centre and the interaction with secondary care referring centre; provided insights from both sides of the secondary/tertiary care interaction and then edited the initial contribution of the section to a more manageable section; ensured relevance of the data collected for the project along with final manuscript editing and approval. KM: consultant transplant surgeon; contributed to the section in part 2 on transplant surgery and outcomes; also provided input in part 1 in the section on transplant assessment and previous surgery; critical role in the planning and acquisition of data for inclusion in the guideline, along with evaluation of relevance to the project; final manuscript editing and approval. DM: consultant transplant surgeon; co-authored the section on transplant surgery with KM and post-transplant surgical complications; also provided input in part 1 in the section on transplant assessment and previous surgery; critical role in the planning and acquisition of data for inclusion in guideline, along with evaluation of relevance to the project; final manuscript editing and approval. JN: consultant transplant hepatologist; wrote the section on post-transplant Immunosuppression with the aid of AC; also contributed to part 1 in an editorial role, when he helped with the original concept; provided a critical role following the original guideline production and prior to its splitting into two halves (parts 1 and 2) and ensuring correct focus was maintained when the manuscript was reduced in size. RP: consultant transplant surgeon; wrote the section on organ allocation and donation; also made a significant contribution to the postoperative care and complications sections and the preop evaluation (part 1); critical role in the planning and acquisition of data for inclusion in the guideline, along with evaluation of relevance to the project; final manuscript editing and approval. AP: liver pharmacist; contributed to part 2, immunosupression section, but also gave useful input into parts 1 and 2 from the point of view of medication and drug interactions, particularly with viral hepatitis treatment; critical role in evaluating data for inclusion in the guideline, along with maintaining relevance to the project; final manuscript editing and approval. WP: consultant in palliative care; authored the section on palliative care and transplantation in part 1; contributed in part 2 via proofreading and providing critical input; critical role in the planning and acquisition of data for inclusion in the guideline, along with evaluation of relevance to the project; final manuscript editing and approval. LS: transplant coordinator; contributed to the section on how to refer a patient for liver transplant (part 1) and gave input into the section on organ allocation (part 2); critical role in the planning and acquisition of data for inclusion in the guideline, along with evaluation of relevance to the project; final manuscript editing and approval. KS: consultant transplant hepatologist; wrote the section on 'when to refer' in part 1, but also gave significant editorial input to the entire project, at the time of the section merge and subsequent division into two halves; critical role in planning and acquisition of data for inclusion into guideline, along with evaluation of relevance to project; final manuscript editing and approval. DTh and RW: consultant transplant hepatologists; coauthored the section on transplant outcomes; provided critical input into part 1 as well, with respect to the referral process; critical role in the planning and acquisition of data for inclusion in guideline, along with evaluation of relevance to the project; final manuscript editing and approval. DTr: consultant transplant hepatologist; coauthored the section on postoperative care and complications (non-surgical); also supported the entire process by helping the lead author with editing sections and discussion of tables and pictures and deciding on section inclusion, data relevance and final manuscript editing and approval.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Linked Articles
- UpFront