P380 Inpatients with advanced alcohol-related liver disease are not being considered for transplantation: a regional audit
| Autor: | Fenella Marley, Emma Saunsbury, Fakhirah Badrulhisham, Ashwin Dhanda, Laura Backhouse, Nauman Babar, James Nott, Anju Phoolchund, Nigel Keelty, Kathryn Wright, Hannah Donnelly, Irene Lee |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment media_common.quotation_subject Alcoholic hepatitis Liver transplantation Abstinence medicine.disease Transplantation Liver disease Internal medicine Ascites medicine Decompensation medicine.symptom business Hepatic encephalopathy media_common |
| Zdroj: | Posters. |
| DOI: | 10.1136/gutjnl-2020-bsgcampus.454 |
| Popis: | Introduction Alcohol-related liver disease (ArLD) remains a leading cause of premature mortality in the UK. In 2018/9 there were over 330,000 alcohol-specific hospital admissions and 5600 deaths. Although many of these patients have advanced disease and multiple admissions, there is a lack of data around access to liver transplantation. Method A spot audit of all inpatients with ArLD was performed in 9 hospitals in the South West on a single day in February 2020. Anonymised data was collected using a standardised collection form on patient characteristics and documentation of consideration for transplantation. Result 9 hospitals provided data: 1 tertiary, 2 large acute trusts and 6 district generals. 31 inpatients (20 [65%] male; median age 62 years [IQR 50–70]) were included. None were liver transplant recipients. 11 patients (35%) had alcoholic hepatitis. 90% had decompensation of ArLD: 84% had ascites (15% treated for SBP), 39% hepatic encephalopathy and 13% upper GI bleeding. Median UKELD was 58 (IQR 55–62) and MELD 21.5 (IQR 19–25). 56% had Child Pugh C and 39% Child Pugh B severity. 55% of patients were drinking alcohol at admission. 48% were known to alcohol services. Where data were available (14 cases) median intake of alcohol was 63 units/week (IQR 32–96). In the abstinent group, median duration of abstinence was 6 months (IQR 1.6–12). Only 2 patients (6%) had documentation in the notes of being considered for transplantation (both deemed ‘too early’). 1 patient had been referred for assessment at a transplant unit. There was no documentation in patient records in the remaining 28 patients (90%). In this group, eligibility for transplantation was considered. 19 patients were deemed illegible. Data were not available for 9 patients (figure 1). Conclusion This regional spot audit demonstrates that inpatients with ArLD have advanced disease and suggests that this group is not routinely being considered for liver transplantation. We acknowledge that our data are limited by availability and accuracy of documentation in patient records. Although a small sample size, this represents inpatients in a variety of hospital settings across the whole of the South West. We aim to use this as a pilot for a national audit to evaluate access of ArLD patients to liver transplantation. |
| Databáze: | OpenAIRE |
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