Long-term outcomes of liver transplant recipients followed up in non-transplant centres: Care closer to home

Tsien, Cynthia; Tan, Huey; Sharma, Sowmya; Palaniyappan, Naaventhan; Wijayasiri, Pramudi; Leung, Kristel; Hayre, Jatinder; Mowlem, Elizabeth; Kang, Rachel; Eddowes, Peter J.; Wilkes, Emilie; Venkatachalapathy, Suresh V.; Guha, Indra N.; Antonova, Lilia; Cheung, Angela C.; Griffiths, William J.H.; Butler, Andrew J.; Ryder, Stephen D.; James, Martin W.; Aithal, Guruprasad P.; Aravinthan, Aloysious D.

Abstract

Introduction: Increasing rates of liver transplantation and improved outcomes have led to greater numbers of transplant recipients followed up in non-transplant centres. Our aim was to document long-term clinical outcomes of liver transplant recipients managed in this ‘hub and spoke’ healthcare model.

Methods: A retrospective analysis of all adult patients who underwent liver transplantation between 1987 and 2016, with post-transplant follow-up in two non-transplant centres in the UK (Nottingham) and Canada (Ottawa) was performed.

Results: The 1-, 5-, 10- and 20-year patient survival rates were 98%, 95%, 87% and 62%, and 100%, 96%, 88% and 62% in the Nottingham and Ottawa groups, respectively (p=0.87). There were no significant differences between the two centres in 1-, 5-, 10- and 20-year cumulative incidence of death-censored graft-survival (p=0.10), end-stage renal disease (p=0.29) or de novo cancer (p=0.22). Nottingham had a lower incidence of major cardiovascular events (p=0.008).

Conclusion: Adopting a new model of healthcare provides a means of delivering post-transplant patient care close to home, without compromising patient survival and long-term clinical outcomes.

Citation

Tsien, C., Tan, H., Sharma, S., Palaniyappan, N., Wijayasiri, P., Leung, K., …Aravinthan, A. D. (2021). Long-term outcomes of liver transplant recipients followed up in non-transplant centres: Care closer to home. Clinical Medicine, 21(1), e32-e38. https://doi.org/10.7861/clinmed.2020-0609

• Journal Article Type: Article
• Acceptance Date: Oct 5, 2020
• Online Publication Date: Jan 21, 2021
• Publication Date: 2021-01
• Deposit Date: Oct 13, 2020
• Publicly Available Date: Jan 22, 2022
• Journal: Clinical Medicine
• Print ISSN: 1470-2118
• Electronic ISSN: 1473-4893
• Publisher: Royal College of Physicians
• Peer Reviewed: Peer Reviewed
• Volume: 21
• Issue: 1
• Pages: e32-e38
• DOI: https://doi.org/10.7861/clinmed.2020-0609
• Keywords: Liver transplantation; Long-term outcomes; Non-transplant centres; Hub and spoke model
• Public URL: https://nottingham-repository.worktribe.com/output/4961784
• Publisher URL: https://www.rcpjournals.org/content/clinmedicine/21/1/e32