Three decades of the Irish National Liver Transplant Program

Three decades of the Irish National Liver Transplant Program written by Dr Julia Sopena Falco and Professor P Aiden McCormick.

22, 23, 24 – HPN January 2022 Digital

In 1993, St Vincent’s University Hospital established the Irish National Liver Transplant Program. Since then over 1,000 patients have received a transplant. Currently the program is staffed by five transplant surgeons in addition to five hepatologists.

The hospital also hosts the national pancreas transplant program and is the national referral centre for primary cancers of the liver and pancreas and for neuroendocrine tumours (NET).

Survival figures are excellent with > 92% survivals at one year for elective patients. However, the program is limited to adult transplant only.

The numbers of patients requiring paediatric liver-transplant are small but these patients are currently referred to King’s College Hospital in the United Kingdom.

For instance, over the past three decades there have been significant changes in the indications for transplant. In addition, autoimmune liver disease, with the exception of primary sclerosing cholangitis, is less common.

Although, transplants for hepatocellular carcinoma and alcoholic liver disease have increased.

However, medical therapy for hepatitis B, C and Budd-Chiari syndrome has improved with reduced requirement for liver transplantation.

New indications such as cystic fibrosis liver disease, multi-visceral transplant and cholangiocarcinoma have become accepted.

Therefore, it is hoped the introduction of normothermic machine perfusion for donor organs will help to increase transplant availability.

References

1. Mongan D, McCormick PA, O’Hara S, Smyth B, Long J. Can Ireland’s increased rates of alcoholic liver disease morbidity and mortality be explained by per capita alcohol consumption? Alcohol Alcohol. 2011;46(4):500.

2. Mathurin P, Moreno C, Samuel D, Dumortier J, Salleron J, Durand F, et al. Early liver transplantation for severe alcoholic hepatitis. N Engl J Med. 2011;365(19):1790-800.

3. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334(11):693-9.

4. Duignan S, Maguire D, Ravichand CS, Geoghegan J, Hoti E, Fennelly D, et al. Neoadjuvant chemoradiotherapy followed by transplantation for unresectable cholangiocarcinoma: a singlecentre national experience. HPB
(Oxford). 2014;16(1):91-8.

5. Alukal JJ, Zhang T, Thuluvath PJ. Mortality and health care burden of Budd Chiari syndrome in the United States: A nationwide analysis (1998-2017). World J Hepatol. 2021;13(6):686-98.

6. Mergental H, Laing RW, Kirkham AJ, Perera M, Boteon YL, Attard J, et al. Transplantation of discarded livers following viability testing with normothermic machine perfusion. Nat Commun. 2020;11(1):2939.

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