P058 The impact of national liver offering scheme on the post-transplant course of patients with alcohol related liver disease: a friend or a foe?

• Published in: Gut Vol. 70; no. Suppl 3; p. A44
• Main Authors: Pradeep, Agimol, Webzell, Ian, Khorsandi, Shirin, Shah, Naina, Mercer, Karen, Prachalias, Andreas, Aluvihare, Varuna, Suddle, Abid, Ramos, Katie, Stratton, Leanne Stratton, Menon, Krishna, Littlejohn, Wendy
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 17.09.2021; BMJ Publishing Group LTD
• Subjects: Alcohol; Liver diseases; Liver transplantation; Transplants & implants
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2021-BASL.67

IntroductionThe National Liver Offering Scheme (NLOS) was introduced in March 2018, this is based upon the scoring system called the Transplant benefit score (TBS) to achieve best outcomes in the adult recipients.AimTo ascertain the impact of the TBS on the transplant waiting list and Alcohol relapse rates in patients transplanted for Alcohol related Liver disease (ArLD).MethodsThis is a retrospective single centre study comparing patients in pre-TBS (March 2016-March 2018) and the post-TBS (March 2018-March 2020) period undergoing Liver transplantation (LT) for ArLD. Data were extracted from a prospectively maintained Liver transplant database. The data were analysed using the non parametric t test.ResultsIn the pre-TBS period, n=76 patients underwent LT for ArLD and in the post TBS, n=94. 14% (11/76) patients in the pre-TBS and 9% (9/94) patients in the post-TBS group relapsed to Alcohol. The median waiting time on the transplant list of the patients who relapsed was 70 (29±271) days and in the post-TBS was 8 (6±50) days, p=0.02. Time to relapse in the pre-TBS period was 425 (240±810) days and in the post-TBS was 328 (136±405) days, p=ns. 2/11 died in the pre-TBS group due to the recurrence of ArLD and 4/9 died in the post-TBS group, two of these had recurrence of ArLD.ConclusionThe introduction of TBS has certainly had a positive impact by leading to a shorter transplant wait time for recipients with ArLD. Though the time to relapse appeared shorter in the post-TBS group, it did not appear to produce any significant increase in mortality compared to the pre-TBS group. Further long-term data is required to ascertain the influence of waiting time on the risk of relapse and prognosis.However, robust screening and timely intervention is required to reduce the risk of Alcohol relapse. The utility of digital tools in the remote monitoring of Alcohol use disorder needs to be explored for early identification of Alcohol relapse.