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. 2021 Jan;21(1):e32-e38.
doi: 10.7861/clinmed.2020-0609.

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

Cynthia Tsien  1 , Huey Tan  2 , Sowmya Sharma  3 , Naaventhan Palaniyappan  2 , Pramudi Wijayasiri  2 , Kristel Leung  4 , Jatinder Hayre  5 , Elizabeth Mowlem  6 , Rachel Kang  7 , Peter J Eddowes  2 , Emilie Wilkes  2 , Suresh V Venkatachalapathy  2 , Indra N Guha  2 , Lilia Antonova  8 , Angela C Cheung  1 , William Jh Griffiths  6 , Andrew J Butler  6 , Stephen D Ryder  2 , Martin W James  2 , Guruprasad P Aithal  2 , Aloysious D Aravinthan  9
Affiliations

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

Cynthia Tsien et al. Clin Med (Lond). 2021 Jan.

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.

Keywords: hub-and-spoke model; liver transplantation; long-term outcomes; non-transplant centres,.

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Figures

Fig 1.
Fig 1.
a) Estimates of patient survival following liver transplantation. b) Estimates of death-censored graft survival following liver transplantation.
Fig 2.
Fig 2.
a) Estimated glomerular filtration rate levels of patients since liver transplant. b) Estimates of the development of end-stage renal disease of patients since liver transplant.
Fig 3.
Fig 3.
a) Weight of patients since liver transplant. b) Estimates of the development of major cardiovascular events of patients since liver transplant.
Fig 4.
Fig 4.
Estimates of the development of de novo cancer in liver transplant patients.
See this image and copyright information in PMC

References

    1. Adam R, Karam V, Delvart V, et al. Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol 2012;57:675–88. - PubMed
    1. Watt KD. Keys to long-term care of the liver transplant recipient. Nat Rev Gastroenterol Hepatol 2015;12:639–48. - PubMed
    1. Neuberger J. Liver transplantation in the United Kingdom. Liver Transpl 2016;22:1129–35. - PubMed
    1. Sequist TD. Ensuring equal access to specialty care. N Engl J Med 2011;364:2258–9. - PubMed
    1. Huitema AA, Harkness K, Heckman GA, McKelvie RS. The spoke-hub-and-node model of integrated heart failure care. Can J Cardiol 2018;34:863–70. - PubMed