Outcomes of incoming and outgoing second opinions from a UK liver transplant centre
Objective Second transplant centre opinions (STCOs) for patients declined for liver transplantation are infrequent. We aimed to identify STCOs outcomes from a tertiary transplant centre.Design Referrals between 2012 and 2020 to Birmingham Unit were reviewed. Incoming: all referrals from out-of-regio...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-04-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/9/1/e000987.full |
| _version_ | 1811182116329750528 |
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| author | Alexander Boyd Neil Rajoriya James Neuberger Matthew J Armstrong Kerry Webb Sara Mahgoub Sean Morris Alessandro Parente |
| author_facet | Alexander Boyd Neil Rajoriya James Neuberger Matthew J Armstrong Kerry Webb Sara Mahgoub Sean Morris Alessandro Parente |
| author_sort | Alexander Boyd |
| collection | DOAJ |
| description | Objective Second transplant centre opinions (STCOs) for patients declined for liver transplantation are infrequent. We aimed to identify STCOs outcomes from a tertiary transplant centre.Design Referrals between 2012 and 2020 to Birmingham Unit were reviewed. Incoming: all referrals from out-of-region centres were collated. Outgoing: patients not listed in Birmingham were reviewed to identify referrals for STCOs to the other UK centres (A–F).Results 2535 patients were assessed for liver transplantation during the study period. Incoming: among 1751 referrals, 23 STCOs (17 unit A, 3 unit B, 1 unit C, 1 unit D and 1 unit E) were provided by Birmingham. Of the STCOs, 13/23 (57%) patients remained unsuitable for transplantation. Therefore, 10/23 (43%) underwent a second liver transplant assessment, of whom five (50%) were still deemed unsuitable, three (30%) listed (one transplanted) and two (20%) died preassessment. Outgoing: among 426 patients not listed, eight (1.8%) patients were referred for STCO (4 unit E, 2 unit B, 1 unit D, 1 unit A). Three (38%) were listed, two (25%) were assessed and declined, two (25%) were unsuitable for assessment and one (12.5%) died while waiting. Combining incoming and outgoing Birmingham STCOs (n=31), six (19%) of STCOs were listed in a second centre.Conclusion Second transplant centre opinions are rare with the majority still deemed unsuitable for liver transplantation. This highlights potential resource implications especially when undergoing a full second formal assessment. A streamlined STCO process with sharing of investigations and use of telemedicine in appropriate patients may allow for greater transparency, quicker decision making and less use of labour-intensive resources. |
| first_indexed | 2024-04-11T09:27:40Z |
| format | Article |
| id | doaj.art-3478bc510fe34b4db545275dc44f3788 |
| institution | Directory Open Access Journal |
| issn | 2054-4774 |
| language | English |
| last_indexed | 2024-04-11T09:27:40Z |
| publishDate | 2022-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj.art-3478bc510fe34b4db545275dc44f37882022-12-22T04:31:59ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742022-04-019110.1136/bmjgast-2022-000987Outcomes of incoming and outgoing second opinions from a UK liver transplant centreAlexander Boyd0Neil Rajoriya1James Neuberger2Matthew J Armstrong3Kerry Webb4Sara Mahgoub5Sean Morris6Alessandro Parente7Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UKLiver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UKLiver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UKLiver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UKLiver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UKLiver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UKLiver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UKLiver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UKObjective Second transplant centre opinions (STCOs) for patients declined for liver transplantation are infrequent. We aimed to identify STCOs outcomes from a tertiary transplant centre.Design Referrals between 2012 and 2020 to Birmingham Unit were reviewed. Incoming: all referrals from out-of-region centres were collated. Outgoing: patients not listed in Birmingham were reviewed to identify referrals for STCOs to the other UK centres (A–F).Results 2535 patients were assessed for liver transplantation during the study period. Incoming: among 1751 referrals, 23 STCOs (17 unit A, 3 unit B, 1 unit C, 1 unit D and 1 unit E) were provided by Birmingham. Of the STCOs, 13/23 (57%) patients remained unsuitable for transplantation. Therefore, 10/23 (43%) underwent a second liver transplant assessment, of whom five (50%) were still deemed unsuitable, three (30%) listed (one transplanted) and two (20%) died preassessment. Outgoing: among 426 patients not listed, eight (1.8%) patients were referred for STCO (4 unit E, 2 unit B, 1 unit D, 1 unit A). Three (38%) were listed, two (25%) were assessed and declined, two (25%) were unsuitable for assessment and one (12.5%) died while waiting. Combining incoming and outgoing Birmingham STCOs (n=31), six (19%) of STCOs were listed in a second centre.Conclusion Second transplant centre opinions are rare with the majority still deemed unsuitable for liver transplantation. This highlights potential resource implications especially when undergoing a full second formal assessment. A streamlined STCO process with sharing of investigations and use of telemedicine in appropriate patients may allow for greater transparency, quicker decision making and less use of labour-intensive resources.https://bmjopengastro.bmj.com/content/9/1/e000987.full |
| spellingShingle | Alexander Boyd Neil Rajoriya James Neuberger Matthew J Armstrong Kerry Webb Sara Mahgoub Sean Morris Alessandro Parente Outcomes of incoming and outgoing second opinions from a UK liver transplant centre BMJ Open Gastroenterology |
| title | Outcomes of incoming and outgoing second opinions from a UK liver transplant centre |
| title_full | Outcomes of incoming and outgoing second opinions from a UK liver transplant centre |
| title_fullStr | Outcomes of incoming and outgoing second opinions from a UK liver transplant centre |
| title_full_unstemmed | Outcomes of incoming and outgoing second opinions from a UK liver transplant centre |
| title_short | Outcomes of incoming and outgoing second opinions from a UK liver transplant centre |
| title_sort | outcomes of incoming and outgoing second opinions from a uk liver transplant centre |
| url | https://bmjopengastro.bmj.com/content/9/1/e000987.full |
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