P117 National liver offering scheme at 5 years – Has it delivered?

• Published in: Gut Vol. 72; no. Suppl 3; pp. A90 - A91
• Main Authors: Taylor, Rhiannon, Rowe, Ian, Thorburn, Douglas
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.09.2023
• Subjects: Donors; Hepatitis B; Ischemia; Liver; Liver transplantation; Mortality; Patients; Statistical analysis; Transplants & implants; United Kingdom > UK
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2023-BASL.131

IntroductionThe National Liver Offering Scheme (NLOS) was implemented on 20 March 2018 to offer livers from deceased donors after brain death (DBD) to the national adult waiting list based on calculated transplant benefit at 5 years. Prior to 2018, livers were offered to transplant centres on a geographical basis for local allocation and this remains in place for livers from donors after circulatory death (DCD). As the scheme has now been in place for five years, we examined the impact of NLOS on patients registered on the list and post-transplant outcome.MethodsData on 5269 adult patients on the UK liver transplant list between March 2018 and March 2023 were obtained from the UK Transplant Registry. Data on 4304 deceased DBD liver transplants performed in the UK during the same period were also obtained.ResultsThe one-, three- and six-month mortality rates after registration were lower in all years since NLOS was implemented, apart from the period of maximal COVID-related disruption (2020/2021), than during the year prior to NLOS.Three thousand five hundred and seventy-four (68%) of the 5269 registrations culminated in a patient receiving a transplant. The proportion transplanted was similar for both new registrations and patients on the list at the introduction of NLOS (68% and 66% respectively). The overall mortality rate was 10% and was similar for both new registrations and patients on the list at the introduction of NLOS (10% and 12% respectively). The mortality rate for patients requiring a first transplant ranged between 4% for patients with Hepatitis B and 13% for cancer patients (table 1). Older patients aged 50 years or over had a higher mortality rate than younger patients aged less than 25 years (11% and 5% respectively).For patients transplanted, the median cold ischaemia time ranged from 8.8 hours to 9.1 hours by year since NLOS was introduced and was 8.54 hours in the year prior to NLOS. There was no statistically significant difference in 90-day or one year post-transplant patient and transplant survival (log-rank p-value>0.1).Abstract P117 Table 1Mortality rate by aetiology for adult elective patients on the liver list, March2018 – March2023 No. registrations N (%) died/removed due to condition deterioration First Cancer 931 123 (13) HCV 114 13 (11) ALD 1401 137 (10) HBV 67 3 (4) PSC 557 20 (5) PBC 338 17 (5) AID 352 28 (8) NAFLD 539 58 (11) Metabolic 80 9 (11) Other 469 45 (10) Overall first 4848 463 (10) Regraft 421 74 (18) ConclusionsNLOS was implemented on 20 March 2018 with an aim to maximise patient life years gained from transplantation and minimise mortality on the transplant list. Since NLOS was implemented, a lower six-month and 1-year mortality rate has been observed while excellent post-transplant outcomes have been maintained with a small increase in cold ischaemia times.