Liver Transplantation

Hector Vilca-Melendez, MD, PhD

Consultant Transplant Surgeon

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

NHSBT Annual Report 2014

Patients on the active waiting list for liver transplantation

Patients on the active transplant list at March 2013, by centre

NHSBT Annual Report 2014

King’s had the largest

proportion of the transplant list,

26%

64%

18%

6%

12%

Activity in the waiting list 1–year post-reg-istration

TransplantedWaitingRemovedDead

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

NHSBT Annual Report 2014

NHSBT Annual Report 2014

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

Deceased donor liver only adult transplants last 10 years, by centre

NHSBT Annual Report 2014

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

Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-140

10

20

30

40

50

60

Enquiry DCDEnquiry DBD

Number of enquiries per month at King’s (Financial Year 2013)

Total NumberDCD = 414DBD = 29

Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-140

10

20

30

40

50

60

70

Non zonalZonal

Number of DCD offers at King’s (Financial Year 2013)

Total Number = 627

Non-zonal = 422Zonal = 205

72%

28% DeclinedAccepted

Total Offers = 627Declined = 452Accepted = 175

DCD offers accepted at King’s (Financial Year 2013)

Total offers accepted = 175

No retrieved = 88Retrieved = 87

DCD offers accepted at King’s (Financial Year 2013)

Declined

Accepted

50%

50%

No retrievedRetrieved

Total grafts retrieved = 87

No transplanted = 51Transplanted = 36

DCD retrieved grafts at King’s (Financial Year 2013)Declined Ac-

cepted

No retrieved

Retrieved

From 627 DCD offersonly 36 liver graftswere transplanted

(5.7%)

59%

41%

No trans-plantedTransplanted

From 175 DCD offersaccepted 36 liver

graftswere transplanted

(20.5%)

Number of DBD offers at King’s (Financial Year 2013)

Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-140

5

10

15

20

25

30

35

40

45

Non ZonalZonal

Total Number = 343

Non-zonal = 185Zonal = 158

DBD offers accepted at King’s (Financial Year 2013)

42%

58%

DeclinedAccepted

Total Offers = 343Declined = 145Accepted = 198

Total offers accepted = 198

No retrieved = 0Retrieved = 198

DCD offers accepted at King’s (Financial Year 2013)

Declined

Accepted

100%

No retrievedRetrieved

Total grafts retrieved = 198

No transplanted = 27Transplanted = 168

DBD retrieved grafts at King’s (Financial Year 2013)Declined

Accepted

Retrieved

14%

86%

No transplanted

Transplanted

From 343 DBD offersonly 168 liver graftswere transplanted

(49%)

From 198 DBD offersaccepted 168 liver

graftswere transplanted

(84.8%)

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

Liver Transplantation at King’s• 90-day mortality and graft loss for adult elective first

liver transplant (Year 2012-2013)

NHSBT Annual Report 2014

Liver Transplantation at King’s

NHSBT Annual Report 2014

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

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

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

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

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)

NHSBT Annual Report 2014

One, three and five year patients survival (Risk adjusted) for adult super urgent first transplants 1 April 2003- 31 March 2013

Paediatric Liver Transplantation - UK• Only 3 centres in the UK perform liver transplantation in

children

NHSBT Annual Report 2014

Deceased donor liver only paediatric transplants last 10 years, by centre

Paediatric Liver Transplantation• Patient survival for paediatric elective first liver

transplant (April 2003- March 2013)

NHSBT Annual Report 2014

Paediatric Liver Transplantation• Patient survival for paediatric super urgent first liver

transplant (April 2003- March 2013)

NHSBT Annual Report 2014

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