Liver Transplantation Hector Vilca-Melendez, MD, PhD Consultant Transplant Surgeon
Jan 04, 2016
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