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Are patients who are rejected for a liver transplantation referred to palliative care?
  1. Molly Stewart1 and
  2. John Speakman2
  1. 1University of Birmingham Medical School, UK
  2. 2Queen Elizabeth Hospital Birmingham

Abstract

Objectives The primary objective was to assess whether a referral to palliative care was made in a sample of end-stage liver disease (ESLD) patients, turned down for a liver transplant, due to being too sick or having a malignancy that excludes them.

The secondary objective was to record the outcomes of: demographics, diagnosis, age when rejected for a liver transplant, length of survival post-rejection for a liver transplant, age at death and place of death.

Methods A retrospective service evaluation of 48 ESLD patients who were rejected for a liver transplant at the Queen Elizabeth Hospital Birmingham (QEHB), due to either being too sick or the liver tumour being inoperable.

Results Of the 48 patients included in the service evaluation, there were a total of 12 referrals (25%) made to palliative care. The most common diagnoses were alcohol-induced cirrhosis (25%), followed by non-alcoholic steatohepatitis (16.7%), Hepatitis C (10.4%) and cryptogenic cirrhosis (10.4%). The mean age at transplant assessment was 59 years old and the mean age at death was 60 years old. The mean length of survival following rejection for a transplant was 72 days. The place of death was difficult to determine for many of the patients due to technology constraints.

Conclusion Better integration of palliative care and liver transplant services is needed to ensure that patients with ESLD are supported in order to ensure the best quality and quantity of life.

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