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Twitter debate: controversies in liver transplantation
  1. Oliver D Tavabie1,
  2. Ankur Srivastava2,
  3. Audrey Dillon3,
  4. Darius Mirza4,
  5. Steven Masson5,
  6. Philip J Smith6
  1. 1Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
  2. 2Department of Gastroenterology and Hepatology, North Bristol NHS Trust, Westbury on Trym, UK
  3. 3Liver Unit, St James’ University Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
  4. 4Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  5. 5Liver Transplant Unit, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  6. 6Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
  1. Correspondence to Dr Oliver D Tavabie, Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK; oliver.tavabie{at}nhs.net

https://doi.org/10.1136/flgastro-2021-101916

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    Key points

    • There is no ‘6-month abstinence’ rule for patients with alcohol-related liver disease in the UK.

    • Cannabis use is not an absolute contraindication for referral for transplant assessment.

    • Whether a new transplant centre should be a UK funding priority is currently debatable.

    • The advent of machine perfusion will increase the number of available grafts for transplantation.

    • Pregnancy is possible for patients post-transplant and should be discussed on a case-by-case basis.

    Introduction

    The first #FGDebates of 2021 tackled ‘Controversies in liver transplantation’ in a double-header inspired by the recent liver transplantation guidelines.1 2 The debates stimulated much discussion with nearly 900 tweets from over 100 participants across the two debates. This fantastic interaction generated a cumulative 3.7 million impressions worldwide with both debates ranking in the top 5 #FGDebates of all time for total impressions made. In this article, we aim to discuss the key discussion points from each of the #FGDebates.

    Assessing patients with alcohol use disorders

    Liver transplantation for patients with alcohol use disorders (AUDs) has historically been viewed as a controversial area for both the general public and healthcare profession. This was largely due to the perceived ‘self-inflicted’ component and the risk of recidivism post-transplant.3 However, the majority of our attendees felt that it was the correct time to assess our patient with an AUD (figure 1) and alcohol-related liver disease remains the most common aetiology at registration for liver transplantation in the UK with good long-term outcomes.4 A common misconception is that patients require a period of 6 months abstinence prior to referral for assessment. While a period of 3 months abstinence may demonstrate the potential for recompensation, there is no absolute rule for abstinence duration prior to assessment in the UK other than patients must be abstinent.1 However, these patients should be assessed for their individual risk of return to drinking and should …

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    Footnotes

    • Twitter @DrPhilipJSmith

    • Contributors ODT drafted the initial manuscript. AS, AD, DM, SM and PJS critically appraised and revised 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.

    • Map disclaimer The depiction of boundaries on the map(s) in this article does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

    • Competing interests OT is a Trainee Associate Editor at Frontline Gastroenterology and has received grants for educational content from Gilead and for consumables from NIHR BRC. PJS is an Associate Editor at Frontline Gastroenterology. There are no other competing interests to declare.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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