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Risk-adjusted survival in liver transplant patients assessed and managed by a non-transplanting centre: South West Liver Unit experience
  1. Benjamin Charles Norton1,2,
  2. Ankur Srivastava3,
  3. Katie Ramos2,
  4. Louisa Vine2,
  5. Rhiannon Taylor4,
  6. Varuna Aluvihare5,
  7. Nigel Heaton5,
  8. Matthew E Cramp2
  1. 1General Medicine, King's College Hospital, London, UK
  2. 2South West Liver Unit, Plymouth Hospitals NHS Trust, Plymouth, UK
  3. 3Department of Gastroenterology and Hepatology, Southmead Hospital, Bristol, UK
  4. 4Statistics and Clinical Studies, NHS Blood and Transplant, Watford, Hertfordshire, UK
  5. 5Institute of Liver Studies, Department of Hepatology, King's College Hospital, London, UK
  1. Correspondence to Dr Benjamin Charles Norton, General Medicine, King's College Hospital, London, UK, SE5 9RS; benjamin.norton{at}nhs.net

Abstract

Background Liver 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.

Design Retrospective 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.

Results We 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.

Conclusions Risk-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.

  • liver transplantation
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Footnotes

  • Contributors BCN, AS, KR and MEC completed the data collection and write-up of the manuscript. RT completed the data analysis. LV, NH and VA helped outline the scope of the project and provided key input into the write-up. BCN is nominated as the guarantor of the manuscript.

  • 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.

  • Data availability statement Data are available upon reasonable request. This includes the 1-year, 5-year and 10-year post-listing data and the 1-year and 5-year post-transplant outcome data as provided by NHSBT. Raw data are not available due to confidentiality. Applications should be directed to NHSBT.

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