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

Patients on the active waiting list for liver transplantation NHSBT Annual Report 2014

Patients on the active transplant list at March 2013, by centre King’s had the largest proportion of the transplant list, 26% NHSBT Annual Report 2014

At one year post-registration 64% of patients had received a transplant and 18% were still waiting. 18% were removed (6%) or died (12%)1

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

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 DCD (136) has been steadily increasing, DBD (648) and living liver transplants (31) increased NHSBT Annual Report 2014

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

Number of enquiries per month at King’s (Financial Year 2013) Total Number DCD = 414 DBD = 29

Number of DCD offers at King’s (Financial Year 2013) Total Number = 627 Non-zonal = 422 Zonal = 205

DCD offers accepted at King’s (Financial Year 2013) Total Offers = 627 Declined = 452 Accepted = 175

DCD offers accepted at King’s (Financial Year 2013) Total offers accepted = 175 No retrieved = 88 Retrieved = 87

DCD retrieved grafts at King’s (Financial Year 2013) Total grafts retrieved = 87 No transplanted = 51 Transplanted = 36 From 627 DCD offers only 36 liver grafts were transplanted (5.7%) From 175 DCD offers accepted 36 liver grafts were transplanted (20.5%)

Number of DBD offers at King’s (Financial Year 2013) Total Number = 343 Non-zonal = 185 Zonal = 158 More Non-Zonal than Zonal… we get livers that nobody wants

DBD offers accepted at King’s (Financial Year 2013) Total Offers = 343 Declined = 145 Accepted = 198

DCD offers accepted at King’s (Financial Year 2013) Total offers accepted = 198 No retrieved = 0 Retrieved = 198

DBD retrieved grafts at King’s (Financial Year 2013) Total grafts retrieved = 198 No transplanted = 27 Transplanted = 168 From 343 DBD offers only 168 liver grafts were transplanted (49%) From 198 DBD offers accepted 168 liver grafts were 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) One, three and five year patients survival (Risk adjusted) for adult super urgent first transplants 1 April 2003- 31 March 2013 NHSBT Annual Report 2014

Paediatric Liver Transplantation - UK Only 3 centres in the UK perform liver transplantation in children Deceased donor liver only paediatric transplants last 10 years, by centre NHSBT Annual Report 2014

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