scholarly journals Risk-adjusted survival in liver transplant patients assessed and managed by a non-transplanting centre: South West Liver Unit experience

2019 ◽  
Vol 11 (3) ◽  
pp. 202-208
Author(s):  
Benjamin Charles Norton ◽  
Ankur Srivastava ◽  
Katie Ramos ◽  
Louisa Vine ◽  
Rhiannon Taylor ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Deceased Donor ◽  
Survival Outcomes ◽  
College Hospital ◽  
Transplant Survival ◽  
Post Transplant ◽  
Transplant Patients ◽  
South West ◽  
Liver Unit ◽  
The Uk

BackgroundLiver 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.DesignRetrospective 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.ResultsWe 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.ConclusionsRisk-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.

Su1439 Impact of Pre Transplant HCV Treatment With DAAs on Post-Transplant Survival Among Deceased-Donor Liver Transplant Recipients

2016 ◽  
Vol 150 (4) ◽  
pp. S1100
Author(s):  
Abdelhai Abdelqader ◽  
Arif M. Cosar ◽  
Ashwini Niranjan-Azadi ◽  
Harry T. Luu ◽  
Saleh Alqahtani ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Deceased Donor ◽  
Transplant Recipients ◽  
Donor Liver ◽  
Hcv Treatment ◽  
Transplant Survival ◽  
Post Transplant ◽  
Donor Liver Transplant ◽  
Liver Transplant Recipients

PTH-124 Liver transplant outcomes in patients with care devolved to a non-transplanting centre: south west liver unit experience

Gut ◽  
2015 ◽  
Vol 64 (Suppl 1) ◽  
pp. A462.2-A463
Author(s):  
BC Norton ◽  
D Adebayo ◽  
K Ramos ◽  
A Smith ◽  
M Cramp
Keyword(s):  
Liver Transplant ◽  
Transplant Outcomes ◽  
South West ◽  
Liver Unit

scholarly journals Using time-varying models to estimate post-transplant survival in pediatric liver transplant recipients

PLoS ONE ◽  
2018 ◽  
Vol 13 (5) ◽  
pp. e0198132 ◽  
Author(s):  
Cindy L. Bryce ◽  
Chung Chou H. Chang ◽  
Yi Ren ◽  
Jonathan Yabes ◽  
Gabriel Zenarosa ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Time Varying ◽  
Transplant Recipients ◽  
Transplant Survival ◽  
Post Transplant ◽  
Pediatric Liver ◽  
Liver Transplant Recipients ◽  
Time Varying Models ◽  
Pediatric Liver Transplant

Medical Management after Liver Transplantation

2019 ◽  
Vol 03 (04) ◽  
pp. 305-313
Author(s):  
Shravan Dave ◽  
Veeral H. Ajmera
Keyword(s):  
Liver Disease ◽  
Liver Transplant ◽  
Medical Management ◽  
High Risk Population ◽  
Nonalcoholic Fatty Liver ◽  
Post Transplant ◽  
Transplant Patients ◽  
Complex Interactions ◽  
Organ Systems

AbstractMedical management of the liver transplant recipient requires consideration of the complex interactions between the transplanted liver, immunosuppression and all organ systems. An aging transplant population, improvement in long-term liver transplant outcomes, and the increase in nonalcoholic fatty liver disease as an indication for transplant have amplified the number of co-morbidities among post-transplant patients. In addition to balancing immunosuppression with infection risk, medical management of the transplanted patient includes monitoring for, and treating, recurrence of the primary liver disease, metabolic syndrome, cardiovascular disease, and post-transplant neurologic and renal dysfunction. Additionally, general healthcare maintenance such as management of osteoporosis, immunizations, and screening for malignancy are essential in this high-risk population. In this review, we summarize the evidence behind best practices for the current medical management of the post liver transplant patient.

scholarly journals Regional Disparities in Transplantation With Deceased Donor Kidneys With Kidney Donor Profile Index Less Than 20% Among Candidates With Top 20% Estimated Post Transplant Survival

2019 ◽  
Vol 29 (4) ◽  
pp. 354-360 ◽  
Author(s):  
S. Ali Husain ◽  
Kristen L. King ◽  
Geoffrey K. Dube ◽  
Demetra Tsapepas ◽  
David J. Cohen ◽  
...  
Keyword(s):  
United States ◽  
Research Question ◽  
Deceased Donor ◽  
The United States ◽  
Strongly Correlated ◽  
Kidney Donor ◽  
Donor Kidney ◽  
Transplant Survival ◽  
Post Transplant ◽  
Deceased Donor Kidney

Introduction: The Kidney Allocation System in the United States prioritizes candidates with Estimated Post-Transplant Survival (EPTS) ≤20% to receive deceased donor kidneys with Kidney Donor Profile Index (KDPI) ≤20%. Research Question: We compared access to KDPI ≤ 20% kidneys for EPTS ≤ 20% candidates across the United States to determine whether geographic disparities in access to these low KDPI kidneys exist. Design: We identified all incident adult deceased donor kidney candidates wait-listed January 1, 2015, to March 31, 2018, using United Network for Organ Sharing data. We calculated the proportion of candidates transplanted, final EPTS, and KDPI of transplanted kidneys for candidates listed with EPTS ≤ 20% versus >20%. We compared the odds of receiving a KDPI ≤ 20% deceased donor kidney for EPTS ≤ 20% candidates across regions using logistic regression. Results: Among 121 069 deceased donor kidney candidates, 28.5% had listing EPTS ≤ 20%. Of these, 16.1% received deceased donor kidney transplants (candidates listed EPTS > 20%: 17.1% transplanted) and 12.3% lost EPTS ≤ 20% status. Only 49.4% of transplanted EPTS ≤ 20% candidates received a KDPI ≤ 20% kidney, and 48.3% of KDPI ≤ 20% kidneys went to recipients with EPTS > 20% at the time of transplantation. Odds of receiving a KDPI ≤ 20% kidney were highest in region 6 and lowest in region 9 (odds ratio 0.19 [0.13 to 0.28]). The ratio of KDPI ≤ 20% donors per EPTS ≤ 20% candidate and likelihood of KDPI ≤ 20% transplantation were strongly correlated ( r 2 = 0.84). Discussion: Marked geographic variation in the likelihood of receiving a KDPI ≤ 20% deceased donor kidney among transplanted EPTS ≤ 20% candidates exists and is related to differences in organ availability within allocation borders. Policy changes to improve organ sharing are needed to improve equity in access to low KDPI kidneys.

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