1. Liver Transplantation
Hector Vilca-Melendez, MD, PhD
Consultant Transplant Surgeon

2. 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

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

4. 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

5. 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

6. Liver Transplantation in the UK
6934 liver transplants were performed in the UK in the last ten year period ( )
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

7. NHSBT Annual Report 2014

8. 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

9. Deceased donor liver only adult transplants last 10 years, by centre
NHSBT Annual Report 2014

10. Cadaveric Organ Donation at King’s
Bi-monthly Organ Donation Audits
Financial year (April 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

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

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

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

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

15. 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%)

16. 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

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

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

19. 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%)

20. 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

21. Liver Transplantation at King’s
90-day mortality and graft loss for adult elective first liver transplant (Year )
NHSBT Annual Report 2014

22. Liver Transplantation at King’s
NHSBT Annual Report 2014

23. 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

24. 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

25. 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

26. Liver Transplantation at King’s
90-day mortality and graft loss for adult super-urgent first liver transplant (Year )
NHSBT Annual Report 2014

27. 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 March 2013
NHSBT Annual Report 2014

28. 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

29. Paediatric Liver Transplantation
Patient survival for paediatric elective first liver transplant (April March 2013)
NHSBT Annual Report 2014

30. Paediatric Liver Transplantation
Patient survival for paediatric super urgent first liver transplant (April March 2013)
NHSBT Annual Report 2014

31. 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