RT Journal Article
SR Electronic
T1 Satellite liver transplant centres significantly improve transplant assessment outcomes for patients with chronic liver disease but not hepatocellular carcinoma: a retrospective cohort study
JF Frontline Gastroenterology
JO Frontline Gastroenterol
FD BMJ Publishing Group Ltd
SP 334
OP 342
DO 10.1136/flgastro-2022-102366
VO 14
IS 4
A1 Tavabie, Oliver D
A1 Kronsten, Victoria T
A1 Przemioslo, Robert
A1 McDougall, Neil
A1 Ramos, Katie
A1 Joshi, Deepak
A1 Prachalias, Andreas
A1 Menon, Krish
A1 Agarwal, Kosh
A1 Heneghan, Michael A
A1 Valliani, Talal
A1 Cash, Johnny
A1 Cramp, Matthew E
A1 Aluvihare, Varuna
YR 2023
UL http://fg.bmj.com/content/14/4/334.abstract
AB Introduction Liver transplantation (LT) remains integral to the management of end-stage chronic liver disease (CLD). However, referral thresholds and assessment pathways remain poorly defined. Distance from LT centre has been demonstrated to impact negatively on patient outcomes resulting in the development of satellite LT centres (SLTCs). We aimed to evaluate the impact of SLTCs on LT assessment in patients with CLD and hepatocellular carcinoma (HCC).Methods A retrospective cohort study was undertaken including all patients with CLD or HCC assessed for LT at King’s College Hospital (KCH) between October 2014 and October 2019. Referral location, social, demographic, clinical and laboratory data were collected. Univariable and multivariable analyses (MVA) were performed to assess the impact of SLTCs on patients being accepted as LT candidates and contraindications being identified.Results 1102 and 240 LT assessments were included for patients with CLD and HCC, respectively. MVA demonstrated significant associations with; patients living greater than 60 min from KCH/SLTCs and LT candidacy acceptance in CLD, and less deprived patients and LT candidacy acceptance in HCC. However, neither variable was associated with identification of LT contraindications. MVA demonstrated that referrals from SLTCs were more likely to result in acceptance of LT candidacy and less likely to result in a contraindication being identified in CLD. However, such associations were not demonstrated in HCC.Conclusion SLTCs improve LT assessment outcomes in CLD but not HCC reflecting the standardised HCC referral pathway. Developing a formal regional LT assessment pathway across the UK would improve equity of access to transplantation.Data are available on reasonable request.