TY - JOUR T1 - Are patients who are rejected for a liver transplantation referred to palliative care? JF - BMJ Supportive & Palliative Care JO - BMJ Support Palliat Care SP - 408 LP - 408 DO - 10.1136/bmjspcare-2016-001204.62 VL - 6 IS - 3 AU - Molly Stewart AU - John Speakman Y1 - 2016/09/01 UR - http://spcare.bmj.com/content/6/3/408.abstract N2 - 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.ReferencesKendrick E. Getting it right: improving end of life care for people with liver disease. North East: Department Of Health; 2014Deaths Registered In England and Wales in2010, by cause. London: Office Of National Statistics; 2011Effiong K, Osinowo A, Pring A, Verne J. Deaths from liver disease: Implications for end of life care in England. National end of life care intelligence network 2012Kaner E, Newbury-Birch D, Avery L, Jackson K, Brown N, Mason H. A rapid review of liver disease epidemiology, treatment and service provision in England. Institute for Health and Society, Newcastle University; 2007Wood A, Arthur C, Myatt R, Sargeant I. Role 4 Trauma Fellowship: The Military Registrar’s Training Experience. Arthroscopy 2012;3:2Adam SJ. Palliative care for patients with a failed liver transplant. Intensive and Critical Care Nursing 2000;16(6):396–402Larson AM, Curtis JR. Integrating palliative care for liver transplant candidates: ‘too well for transplant, too sick for life’. JAMA 2006;295(18):2168–2176Back AL, Arnold RM, Quill TE. Hope for the best, and prepare for the worst. Ann Intern Med 2003;138(5):439–443Saunders DC. First national VOICES survey of bereaved people: key findings report, 2012 ER -