Non-hepatic complications of liver transplant are common and associated with significant morbidity and mortality. The American Association for the Study of Liver Diseases (AASLD) practice guideline on the long-term management of liver transplant recipients aims to assist with modifying the risk of these complications. There is currently no equivalent European guideline. We analysed clinical records from a large UK centre to ascertain whether post-transplant care was comparable to the AASLD standards of care.Methods
Consecutive patients who had been transplanted at two UK centres following referral from a single UK centre between 1988 and 2016 were analysed retrospectively. All clinical documentation and test Results over a 12 month period were analysed. Outcome measures were aligned with AASLD guidelines, including; screening for diabetes, chronic kidney disease, hypertension, dyslipidaemia and osteopenia.Results
48 patients (29 female/19 male) were included in analysis. Mean age was 57 (SD 13.4). Median time since transplantation was six years (IQR 3–13). 10/17 (58.8%) diabetic patients met the recommendation of having their HbA1c measured in the preceding 3 months. Of non-diabetic patients, 15/29 (51.7%) underwent annual fasting glucose (or HbA1c) during the study period. 48/48 (100%) of patients had evidence of renal function monitoring within the last 12 months. Yearly urine albumin-creatinine ratio testing was performed in 10/48 (20.8%). Blood pressure was measured in 13/48 (27%) of patients. Of those, 7/13 (53.8%) had a satisfactory blood pressure of <130/80 mmHg. The recommendation of annual blood lipid measurement took place in 30/48 (62.5%) and annual Vitamin D in 20/48 (41.7%). 8/18 (44.4%) of patients transplanted between 2005 and 2012 underwent a Dual Energy X-ray Absorptiometry (DEXA) scan within 5 years. 12/14 (85.7%) of osteopenic patients were receiving the recommended calcium supplementation, while 2/14 (14.3%) of them were receiving annual Bone Mineral Density testing.Conclusion
Liver transplant recipients in this study did not receive a consistent approach to screening for common non-hepatic complications. Although there was often evidence that these complications were appropriately considered, there was wide variability between patients. The level of monitoring for patients, who are high risk for cardiovascular and metabolic disease, was insufficient overall. Consideration should be made to adoption of models of care which provide standardised recommendations for patients in the post-transplant phase. This may lead to a more rigorous and robust approach to patients’ long-term management, which in turn may reduce late morbidity and mortality.