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• W3201649310 abstract "<h3>Introduction</h3> Liver transplant (LT) has revolutionised management of chronic liver disease. In an era of ever-increasing demand, promoting equity of timely access needs to be a priority. Markers of disease severity including MELD and nutritional status correlate well with waiting list mortality. These variables deteriorate with referral delay. Through analysis of patients referred to a LT unit over a two-year period we sought to establish characteristics that could be used as markers to represent a ‘late’ referral. <h3>Methods</h3> Referrals for liver transplantation for chronic liver disease (CLD) between 1 April 2017- 31 March 2019 were reviewed. Electronic patient records were interrogated to establish patient demographics, severity of disease at referral and assessment outcome. <h3>Results</h3> In this period 371 patient with CLD were referred for LT assessment. Of these, 64% were male and 50% had alcohol related liver disease. Median UKELD at referral was 54 (range 42–72), 58 (16%) UKELD > 60 at referral. 150/371 (40.4%) were listed for transplantation of whom 26 (17%) died on the waiting list. In addition, 19 (5%) of patients died prior to completion of their assessment and 17.9% were not listed because they required further optimisation of clinical status due to frailty or malnutrition. Other patients were declined listing because of medical/surgical contraindications (31.2%), alcohol concerns (9%) and were considered too early (36.1%). In total therefore 144 patients (39%) were unable to access LT because of the advanced nature of their disease. 281 patients (76%) had ascites at referral, 64 (22.8%) had undergone > 5 paracentesis (LVP) procedures prior to referral, 27 (9.6%) had undergone > 10 LVP. A smaller proportion of patients in the >10 LVP group were listed compared with the <10 group (26% vs 35%). A greater proportion of patients in the >10 LVP group died during the study follow-up period compared with <10 group (37% vs 32%). <h3>Conclusion</h3> In this heterogenous population, identifying markers of ‘late referral’ is challenging. A potential surrogate marker identified by this study is number of LVP prior to transplant assessment referral. There are unavoidable late referrals due to late presentation, non-attendance or substance concerns. Failure to recognise the significance of recurrent LVP procedures may represent missed opportunities for earlier referral. It is likely that the reasons behind these later referrals are multi-factorial and further work is needed to identify and improve these modifiable risk factors." @default.
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• W3201649310 date "2021-01-01" @default.
• W3201649310 modified "2023-09-23" @default.
• W3201649310 title "P177 Identifying missed opportunities for transplant assessment: a review of referrals to a liver transplant centre" @default.
• W3201649310 doi "https://doi.org/10.1136/gutjnl-2020-bsgcampus.252" @default.
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