1
|
Tsien C, Tan H, Sharma S, Palaniyappan N, Wijayasiri P, Leung K, Hayre J, Mowlem E, Kang R, Eddowes PJ, Wilkes E, Venkatachalapathy SV, Guha IN, Antonova L, Cheung AC, Griffiths WJ, Butler AJ, Ryder SD, James MW, Aithal GP, Aravinthan AD. Long-term outcomes of liver transplant recipients followed up in non-transplant centres: Care closer to home. Clin Med (Lond) 2021; 21:e32-e38. [PMID: 33479081 DOI: 10.7861/clinmed.2020-0609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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.
Collapse
Affiliation(s)
- Cynthia Tsien
- The Ottawa Hospital, Ottawa, Canada, University of Ottawa, Ottawa, Canada and Ottawa Hospital Research Institute, Ottawa, Canada
| | - Huey Tan
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK, Nottingham University Hospitals NHS Trust, Nottingham, UK and the University of Nottingham, Nottingham, UK
| | | | - Naaventhan Palaniyappan
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK, Nottingham University Hospitals NHS Trust, Nottingham, UK and the University of Nottingham, Nottingham, UK
| | - Pramudi Wijayasiri
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK, Nottingham University Hospitals NHS Trust, Nottingham, UK and the University of Nottingham, Nottingham, UK
| | | | | | | | | | - Peter J Eddowes
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK, Nottingham University Hospitals NHS Trust, Nottingham, UK and the University of Nottingham, Nottingham, UK
| | - Emilie Wilkes
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK, Nottingham University Hospitals NHS Trust, Nottingham, UK and the University of Nottingham, Nottingham, UK
| | - Suresh V Venkatachalapathy
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK, Nottingham University Hospitals NHS Trust, Nottingham, UK and the University of Nottingham, Nottingham, UK
| | - Indra N Guha
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK, Nottingham University Hospitals NHS Trust, Nottingham, UK and the University of Nottingham, Nottingham, UK
| | | | - Angela C Cheung
- The Ottawa Hospital, Ottawa, Canada, University of Ottawa, Ottawa, Canada and Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Stephen D Ryder
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK, Nottingham University Hospitals NHS Trust, Nottingham, UK and the University of Nottingham, Nottingham, UK
| | - Martin W James
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK, Nottingham University Hospitals NHS Trust, Nottingham, UK and the University of Nottingham, Nottingham, UK
| | - Guruprasad P Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK, Nottingham University Hospitals NHS Trust, Nottingham, UK and the University of Nottingham, Nottingham, UK
| | - Aloysious D Aravinthan
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK, Nottingham University Hospitals NHS Trust, Nottingham, UK and the University of Nottingham, Nottingham, UK
| |
Collapse
|
2
|
Lissing M, Nowak G, Adam R, Karam V, Boyd A, Gouya L, Meersseman W, Melum E, Ołdakowska‐Jedynak U, Reiter FP, Colmenero J, Sanchez R, Herden U, Langendonk J, Ventura P, Isoniemi H, Boillot O, Braun F, Perrodin S, Mowlem E, Wahlin S. Liver Transplantation for Acute Intermittent Porphyria. Liver Transpl 2021; 27:491-501. [PMID: 37160035 PMCID: PMC8248103 DOI: 10.1002/lt.25959] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/19/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022]
Abstract
Recurrent attacks of acute intermittent porphyria (AIP) result in poor quality of life and significant risks of morbidity and mortality. Liver transplantation (LT) offers a cure, but published data on outcomes after LT are limited. We assessed the pretransplant characteristics, complications, and outcomes for patients with AIP who received a transplant. Data were collected retrospectively from the European Liver Transplant Registry and from questionnaires sent to identified transplant and porphyria centers. We studied 38 patients who received transplants in 12 countries from 2002 to 2019. Median age at LT was 37 years (range, 18-58), and 34 (89%) of the patients were women. A total of 9 patients died during follow-up, and 2 patients were retransplanted. The 1-year and 5-year overall survival rates were 92% and 82%, which are comparable with other metabolic diseases transplanted during the same period. Advanced pretransplant neurological impairment was associated with increased mortality. The 5-year survival rate was 94% among 19 patients with moderate or no neuropathy at LT and 83% among 10 patients with severe neuropathy (P = 0.04). Pretransplant renal impairment was common. A total of 19 (51%) patients had a GFR < 60 mL/minute. Although few patients improved their renal function after LT, neurological impairments improved, and no worsening of neurological symptoms was recorded. No patient had AIP attacks after LT, except for a patient who received an auxiliary graft. LT is a curative treatment option for patients with recurrent attacks of AIP. Severe neuropathy and impaired renal function are common and increase the risk for poor outcomes. If other treatment options fail, an evaluation for LT should be performed early.
Collapse
Affiliation(s)
- Mattias Lissing
- Hepatology DivisionDepartment of Upper GI DiseasesPorphyria Centre SwedenKarolinska Institutet and Karolinska University HospitalStockholmSweden
| | - Greg Nowak
- Department of Clinical Science, Intervention and Technology (CLINTEC)Karolinska Institutet and Karolinska University HospitalStockholmSweden
| | - René Adam
- Paul Brousse HospitalUniversity Paris‐SudInserm U935VillejuifFrance
| | - Vincent Karam
- Paul Brousse HospitalUniversity Paris‐SudInserm U935VillejuifFrance
| | | | - Laurent Gouya
- Centre Francais des PorphyriesHôpital Louis MourierAssistance Publique‐Hôpitaux de ParisParisFrance
| | - Wouter Meersseman
- Department of General Internal MedicineUniversitair Ziekenhuis (UZ) LeuvenLeuvenBelgium
| | - Espen Melum
- Section for GastroenterologyNorwegian Primary Sclerosing Cholangitis (PSC) Research CenterDepartment of Transplantation MedicineResearch Institute of Internal MedicineDivision of SurgeryInflammatory Diseases and TransplantationOslo University Hospital RikshospitaletHybrid Technology Hub‐Centre of ExcellenceInstitute of Basic Medical SciencesInstitute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
| | | | - Florian P. Reiter
- Liver Center MunichDepartment of Medicine IIUniversity HospitalLudwig Maximilian University (LMU) MunichMunichGermany
| | - Jordi Colmenero
- Liver Transplant UnitHospital Clínic de BarcelonaInstitut d'Investigacions Biomèdiques August Pi i SunyerCentro de Investigación Biomédica en Red en Enfermedades Hepáticas y DigestivasUniversitat de BarcelonaBarcelonaSpain
| | - Rosario Sanchez
- Institute of Sanitary and Biomedical Investigation of AlicanteAlicanteSpain
| | - Uta Herden
- Department of Visceral Transplant SurgeryUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Janneke Langendonk
- Erasmus MCUniversity Medical Center RotterdamPorphyria Center RotterdamRotterdamThe Netherlands
| | - Paolo Ventura
- Department of Medical and Surgical Sciences for Children and AdultsUniversity of Modena and Reggio EmiliaUnit of Internal MedicinePoliclinico Hospital of ModenaModenaItaly
| | - Helena Isoniemi
- Department of Transplantation and Liver SurgeryHelsinki University HospitalHelsinkiFinland
| | | | - Felix Braun
- Department of General, Visceral, Thoracic, Transplantation and Pediatric SurgeryUniversitätsklinikum Schleswig‐Holstein (UKSH)Campus KielKielGermany
| | - Stéphanie Perrodin
- Department of Visceral Surgery and MedicineInselspital University Hospital of BernBernSwitzerland
| | - Elizabeth Mowlem
- The Liver UnitAddenbrooke's HospitalCambridge University HospitalsCambridgeUK
| | - Staffan Wahlin
- Hepatology DivisionDepartment of Upper GI DiseasesPorphyria Centre SwedenKarolinska Institutet and Karolinska University HospitalStockholmSweden
| | | |
Collapse
|