P98 Formal regional referral networks optimize patient selection for liver transplantation. (19th June 2022)

• Record Type: Journal Article
• Authors: Tavabie, Oliver; Kronsten, Victoria; Valliani, Talal; Joshi, Deepak; Cash, Johnny; Suddle, Abid; Cramp, Matthew; Prachalias, Andreas; Menon, Krishna; Agarwal, Kosh; Heneghan, Michael; Aluvihare, Varuna
• Is Part Of: Gut. Volume 71(2022)Supplement 1
• Page Start: A88
• Page End: A88
• Publication Date: 2022-06-19
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2022-BSG.155
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Unlike other conditions with high mortality (eg hepatocellular carcinoma (HCC)) chronic liver disease (CLD) patients (PTs) in the United Kingdom do not have standardised referral pathways. To improve access to liver transplantation (LT), King's College Hospital (KCH) developed a network of satellite LT centres (SLTCs). We aimed to evaluate the impact of SLTCs in LT candidacy evaluation in CLD PTs and those within the established HCC pathway. Methods: All PTs discussed at the KCH LT meeting between 10/2014-10/2019 were included. All second opinions from other centres and PTs without CLD or HCC were excluded. Geographic, referral (KCH, SLTC or conventional referrer (CR)), clinical, demographic and laboratory data were retrospectively recorded. HCC PTs had tumor related variables recorded. CLD and HCC PTs were analyzed separately. Univariate (UVA) and multivariate analyses (MVA) were utilized to assess the impact of SLTCs. Results: 1102 assessments from CLD PTs (CR=512 SLTC=299 KCH=291) and 240 assessments from HCC PTs (CR=110 SLTC=72 KCH=58) were included. HCC PTs were not significantly more likely to be; referred from CRs/SLTCs/KCH, listed or have a contraindication to LT than CLD PTs. 725 CLD PTs were listed and 216 had contraindications to LT. Variables significantly associated with listing included; younger age, autoimmune liver diseases (AILD), biliary atresia (BA), previous LT, higher CLD prognostic scores, shorter referral to decision time and referral from SLTCs. Variables significantly negatively associated with listing included; non-alcoholic fatty liver disease (NAFLD), alcohol related liver disease (ARLD), hepatitis C and referral from CRs. MVA was utilized to demonstrate that referrals from SLTCs remained independently associated with listing (adjusted odds ratio (aOR) 2.92 (95% confidence interval (CI) 2.07-4.17)). Variables associated with contraindication to LT included; older age, ARLD, NAFLD, higher CLD prognostic scores and referral from CRs. Variables negatively associated with contraindication to LT included; AILD, BA, previous LT or referral from SLTC. MVA was utilized to demonstrate that referrals from SLTC remained independently negatively associated with contraindications (aOR 0.33 (95%CI 0.21-0.50)). 168 HCC patients were listed and 55 had contraindications to LT. No variables were significantly associated with listing including referrals from SLTC on UVA or MVA. Older HCC PTs were significantly more likely to have a contraindication to LT but referrals from SLTC did not influence likelihood on UVA or MVA. Conclusions: Formal referral pathways through SLTCs improve PT selection and access to LT for PTs with CLD but do not impact on the well-established HCC pathway.