Long-term outcomes of liver transplant recipients followed up in non-transplant centres: Care closer to home.

Tsien, Cynthia; Tan, Huey; Sharma, Sowmya; Palaniyappan, Naaventhan; Wijayasiri, Pramudi; Leung, Kristel; Hayre, Jatinder; Mowlem, Elizabeth; Kang, Rachel; Eddowes, Peter J; Wilkes, Emilie; Venkatachalapathy, Suresh V; Guha, Indra N; Antonova, Lilia; Cheung, Angela C; Griffiths, William Jh; Butler, Andrew J; Ryder, Stephen D; James, Martin W; Aithal, Guruprasad P; Aravinthan, Aloysious D

INTRODUCTION Increasing rates of liver transplantation and improved outcomes have led to greater numbers of transplant recipients followed up in non-transplant centres. Our aim was to document long-term clinical outcomes of liver transplant recipients managed in this 'hub-and-spoke' healthcare model. METHODS A retrospective analysis of all adult patients who underwent liver transplantation between 1987 and 2016, with post-transplant follow-up in two non-transplant centres in the UK (Nottingham) and Canada (Ottawa), was performed. RESULTS The 1-, 5-, 10- and 20-year patient survival rates were 98%, 95%, 87% and 62%, and 100%, 96%, 88% and 62% in the Nottingham and Ottawa groups, respectively (p=0.87). There were no significant differences between the two centres in 1-, 5-, 10- and 20-year cumulative incidence of death-censored graft-survival (p=0.10), end-stage renal disease (p=0.29) or de novo cancer (p=0.22). Nottingham had a lower incidence of major cardiovascular events (p=0.008). CONCLUSION Adopting a new model of healthcare provides a means of delivering post-transplant patient care close to home without compromising patient survival and long-term clinical outcomes.