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• W3213744662 abstract "<h3>Introduction</h3> In the UK, alcohol related liver disease (ArLD) is the leading indication for liver transplant (LT) wait-listing. Outcomes post LT for ArLD compare very well with those for other aetiologies, with low rates of histological disease recurrence and graft loss. Despite this, studies suggest a prejudice remains towards ArLD amongst medical professionals and therefore acts as a potential barrier to both access and timely referral for LT. All LT centres provide assessment with alcohol specialists to risk stratify & attempt to predict relapse risk, thus enabling appropriate listings. Whilst achieving abstinence leads to improvement in some, there is no requirement for an enforced abstinence period prior to referral for advanced disease patients who are otherwise suitable candidates. This may lead to missed opportunities for some potential recipients. We looked at the outcome of our assessments in ArLD patients to identify what proportion may have benefitted from earlier referral. <h3>Methods</h3> We conducted a retrospective evaluation of all LT assessments for chronic liver disease in a single transplant centre between April 2017 - March 2019. Electronic patient records were interrogated to establish patient demographics, severity of disease at referral and assessment outcome. <h3>Results</h3> ArLD was the primary aetiology in 184/371(49.6%) assessment referrals (131 males (71%), 53 females (29%) with median MELD = 17 (range 6–36); median UKELD = 55 (range 42-72). 170/184 (92%) had ascites at point of referral and of these 29% had undergone >5 drains. The LT multidisciplinary team (MDT) supported listing in 70/184 (38%). 105/184 (57%) were not listed and 9/184 (5%) did not complete the assessment. Of the 57% not listed, 33% had an improving clinical trajectory or alternative treatment option e.g. TIPSS. 24% were too high risk due to comorbidity and 17% were thought to have too high a risk of dependency relapse. However, 19% required further optimisation for frailty or malnutrition and had their assessment conclusions deferred. <h3>Conclusion</h3> Our data show that one fifth of patients assessed for ArLD require optimisation which prevents their listing. Such candidates are usually frail and/or malnourished and represent late stage disease. These may be surrogate markers of late presentation or late referrals e.g. in the case of > 5 paracenteses. New BSG guidelines in 2020 recommend early referral (at three months if no improvement, or earlier if urgent late presentations) for patients with decompensated ArLD. This enables alcohol and allied health specialists additional time to work with patients in order to achieve favourable outcomes. This should provide reassurance and empower referring clinicians, especially those that do not have access to specialist alcohol services in their units." @default.
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• W3213744662 date "2021-11-01" @default.
• W3213744662 modified "2023-09-25" @default.
• W3213744662 title "PWE-25 Deferred liver transplant waitlisting due to prehabilitation supports earlier referral in alcohol related liver disease" @default.
• W3213744662 doi "https://doi.org/10.1136/gutjnl-2021-bsg.215" @default.
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