Liver Transplantation

Background

There are 7 liver transplant units for adult transplantation in the UK and one of these is based in Leeds, within the Yorkshire and Humber region. Leeds Teaching Hospitals NHS Trust also has paediatric liver transplant services, one of only 3 units in the UK to provide such services.

The Liver and Hepatobiliary Unit at St James’s University Hospital in Leeds celebrated its 25th year of transplantation in 2012. Patients are referred for consideration of transplant from a wide geographical area across the North of England.

The Team

The adult medical team consists of:

  • 6 liver transplant surgeons (Mr Niaz Ahmad, Mr Magdy Attia, Mr Ernest Hidalgo, Mr Stephen Pollard, Mr Raj Prasad and Mr Giles Toogood). Live donor transplant services are additionally provided by Prof. Peter Lodge.
  • 5 transplant hepatologists (Dr Mark Aldersley, Dr Lee Claridge, Dr Mervyn Davies, Dr Rebecca Jones and Dr Phaedra Tachtatzis)
  • 7 anaesthetists with expertise also in intensive care (Prof Mark Bellamy, Dr Alwyn Kotze, Dr John McElwaine, Dr Stuart Murdoch, Dr Krishna Rao, Dr Nikki Snook and Dr Bruce Duncan).

For the paediatric team, the children are assessed and managed within the paediatric hepatology service at the Leeds General Infirmary.

In addition there is a team of transplant co-ordinators, all specialist nurses who not only co-ordinate the actual logistics of the transplant, but also co-ordinate patient assessments and contribute to their management on the waiting list. There is a dedicated transplant theatre team, and the unit is supported by specialist liver pharmacists, dieticians, a clinical nurse specialist for alcohol and substance misuse and a social worker.

 Liver transplant co-ordinator team

Live Donor Liver Transplantation

In 2007, the Liver Unit opened its Live Donor Liver Transplant (LDLT) service, and now has one of the most active units in the UK. There is a dedicated live donor co-ordinator and the surgical team consists of experienced hepatobiliary surgeons, many of whom are also transplant surgeons. Enquiries about live donor transplantation can be made to Ms Julie Jeffery by emailing live-donor-clinic@leedsth.nhs.uk or telephoning 0113 2066913.

Activity

The unit is also a National Organ Retrieval Centre and is one of the busiest in the UK.

The unit assesses around 260-300 patients a year for liver transplant, and has about 70 patients active on the transplant waiting list at any time. Around 80-100 transplants are performed each year, between the adult and children’s programmes. Waiting times can be very long, and this can be a very difficult time for both patients and their families or carers. Some patients will unfortunately deteriorate whilst waiting.

Hospital teams wishing to discuss medical management of patients on the transplant waiting list with the Leeds team can contact the Liver Unit Registrar on call via the St James’s University Hospital switchboard 0113 243 3144 and ask for bleep number 4873. Consultants wishing to discuss directly with the consultant on call are welcome to either contact the consultant directly, or leave a request and contact number with the registrar, who discusses all referrals with the on call consultant.

Inpatients

The liver unit ward is managed by Sr Nikki Keep. Ward J83 is situated in the Bexley Wing of St James’s University Hospital. It is a 32 bedded ward and has a mixed inpatient base for the tertiary hepatology and liver transplant service and hepatobiliary surgery.

Outpatients

Most patients are assessed as inpatients, but some are initially assessed through one of the outpatient clinics, and from this some can complete their assessment as outpatients.

Outpatient transplant services include transplant waiting list clinics, an early and later post-transplant clinic and a live donor clinic. These services include clinics with specialist nurses, dieticians and pharmacists as appropriate to patient need.

Governance

The transplant team is a multidisciplinary team (MDT) and is supported by a Transplant MDT meeting, radiology and pathology meeting, all of which are held weekly.

The transplant team is represented in the Hepatobiliary MDT and there is a regular LDLT MDT. The unit holds governance meetings twice a year for a formal review of patient morbidity and mortality. This is soon to be increased to 4 monthly to ensure more regular review. These meetings are attended by an external peer reviewer. A weekly departmental meeting ensures rapid review of national policies and service delivery/development.

Contacts

Liver transplant assessment referrals can be addressed to any of the transplant hepatology consultants at the Department of Hepatology, St James’s University Hospital, Beckett St, Leeds, LS9 7TF. Please include within the referral the indication for transplant assessment, most recent blood tests and details of any pathology or radiology investigations.

Referrals for assessment of hepatocellular carcinoma management, including transplantation should be made through the HBP(Liver)MDT co-ordinators office. Enquiries can be e-mailed to bev.owens@leedsth.nhs.uk or by telephone 0113 2068601.

To inform the liver transplant co-ordinators about patients on the waiting list admitted to local services please contact livertransplant@leedsth.nhs.uk or telephone 0113 2066509. These contacts can also be used for enquiries related to patients undergoing transplant assessment or other queries whilst they are on the waiting list.

Enquiries about live donor transplantation can be addressed to Ms Julie Jeffery by telephone 0113 2066913 or by e-mail live-donor-clinic@leedsth.nhs.uk

The unit can consider privately funded live donor transplant assessment and surgery under a private partnership arrangement with the Leeds Teaching Hospitals NHS Trust for non-NHS entitled patients. Referrers wanting to make enquiries about this service should write to Mr Raj Prasad, Clinical Director (HBP, Transplant and General Surgery), St James’s University Hospital, Beckett St, Leeds, LS9 7TF, UK.