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Liver Transplantation

Liver Transplantation

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Liver Transplantation

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  1. Liver Transplantation Hector Vilca-Melendez, MD, PhD Consultant Transplant Surgeon

  2. Liver Transplantation in the UK • Sir Roy Calne started the first UK liver transplant programme in the UK in 1968 • There are seven liver transplant units in the UK: • Addenbrookes Hospital, Cambridge • Freeman Hospital, Newcastle-upon-Tyne • St James’s University Hospital, Leeds • King’s College Hospital, London • Queen Elizabeth Hospital, Birmingham • Royal Free Hospital, London • Royal Infirmary, Edinburgh

  3. Patients on the active waiting list for liver transplantation NHSBT Annual Report 2014

  4. Patients on the active transplant list at March 2013, by centre King’s had the largest proportion of the transplant list, 26% NHSBT Annual Report 2014

  5. Liver Transplantation in the UK • 6934 liver transplants were performed in the UK in the last ten year period (2003-2013) • 5952 (86%) were deceased donor first liver transplants • 5286 (89%) were adult recipients • 665 (11%) were paediatric patients • 5146 (86%) were elective and 805 (14%) were super-urgent transplants

  6. NHSBT Annual Report 2014

  7. Liver transplantation in the UK, last 10 years Transplants using DCD grafts have been steadily increasing Transplants using DBD and living donor grafts have increased in the last couple of years NHSBT Annual Report 2014

  8. Deceased donor liver only adult transplants last 10 years, by centre NHSBT Annual Report 2014

  9. Cadaveric Organ Donation at King’s • Bi-monthly Organ Donation Audits • Financial year (April 2013 - March 2014) • Number of enquiries (DBD and DCD) • Number of DCD and DBD offers • Local and non-local • Accepted and declined • Retrieved and non-retrieved • Number of liver transplants and utilization • Transplanted and non-transplanted

  10. Number of enquiries per month at King’s (Financial Year 2013) Total Number DCD = 414 DBD = 29

  11. Number of DCD offers at King’s (Financial Year 2013) Total Number = 627 Non-zonal = 422 Zonal = 205

  12. DCD offers accepted at King’s (Financial Year 2013) Total Offers = 627 Declined = 452 Accepted = 175

  13. DCD offers accepted at King’s (Financial Year 2013) Total offers accepted = 175 No retrieved = 88 Retrieved = 87

  14. DCD retrieved grafts at King’s (Financial Year 2013) Total grafts retrieved = 87 No transplanted = 51 Transplanted = 36 From 627 DCD offers only 36 liver grafts were transplanted (5.7%) From 175 DCD offers accepted 36 liver grafts were transplanted (20.5%)

  15. Number of DBD offers at King’s (Financial Year 2013) Total Number = 343 Non-zonal = 185 Zonal = 158

  16. DBD offers accepted at King’s (Financial Year 2013) Total Offers = 343 Declined = 145 Accepted = 198

  17. DCD offers accepted at King’s (Financial Year 2013) Total offers accepted = 198 No retrieved = 0 Retrieved = 198

  18. DBD retrieved grafts at King’s (Financial Year 2013) Total grafts retrieved = 198 No transplanted = 27 Transplanted = 168 From 343 DBD offers only 168 liver grafts were transplanted (49%) From 198 DBD offers accepted 168 liver grafts were transplanted (84.8%)

  19. Liver Transplantation at King’s • Transplant activity: • 90 day patient mortality and graft loss • One-, three- and five-year patient survival rates during the last ten years • Adult elective first liver transplant (risk adjusted) • Adult super urgent first liver transplant (risk adjusted) • Paediatric elective first liver transplant (unadjusted) • Paediatric super urgent first liver transplant (unadjusted) A risk-adjusted survival rate is an estimate of what the survival rate at a centre would have been if they had had the same mix of patients as that seen nationally and therefore it presents estimates in which differences in patient mix across centres have been removed as much as possible

  20. Liver Transplantation at King’s • 90-day mortality and graft loss for adult elective first liver transplant (Year 2012-2013) NHSBT Annual Report 2014

  21. Liver Transplantation at King’s NHSBT Annual Report 2014

  22. Risk-adjusted 1 year patient survival rates for adult elective first liver transplants, last 10 years (April 2003 and March 2013) NHSBT Annual Report 2014

  23. Risk-adjusted 3 year patient survival rates for adult elective first liver transplants, last 10 years (April 2003 and March 2013) NHSBT Annual Report 2014

  24. Risk-adjusted 5 year patient survival rates for adult elective first liver transplants, last 10 years (April 2003 and March 2013) NHSBT Annual Report 2014

  25. Liver Transplantation at King’s • 90-day mortality and graft loss for adult super-urgent first liver transplant (Year 2012-2013) NHSBT Annual Report 2014

  26. Liver Transplantation at King’s • 1, 3 and 5-year survival for adult super-urgent first liver transplant, last 10 years (April 2003 – March 2014) One, three and five year patients survival (Risk adjusted) for adult super urgent first transplants 1 April 2003- 31 March 2013 NHSBT Annual Report 2014

  27. Paediatric Liver Transplantation - UK • Only 3 centres in the UK perform liver transplantation in children Deceased donor liver only paediatric transplants last 10 years, by centre NHSBT Annual Report 2014

  28. Paediatric Liver Transplantation • Patient survival for paediatric elective first liver transplant (April 2003- March 2013) NHSBT Annual Report 2014

  29. Paediatric Liver Transplantation • Patient survival for paediatric super urgent first liver transplant (April 2003- March 2013) NHSBT Annual Report 2014

  30. Conclusions • There is a definitive increased in DCD and DBD donation in the UK • The number of liver transplants is increasing in the UK • There is a lot of effort and resources applied to DCD’s but still the number of transplants performed using these livers is relatively small • DBD’s are still the best source of organs for clinical liver transplantation • King’s College Hospital outcomes for liver transplantation (adult and paediatric) have been consistently good during the last ten years • The work of our SNOD’s is fundamental for the success of our Liver Transplant Programme