Case study: UK-first procedure set to transform long term management of patients following liver transplant
by Mr Parthi Srinivasan
When a patient has received a liver transplant, the lifetime of immunosuppressant drugs required to prevent the donor organ being rejected can have profound implications on their quality of life. For health insurers, managing such patients is not only complex, but also presents unknown and ongoing considerations relating to their cost of care.
Immunosuppressant regimens work by making the patient’s immune system weaker and less able to reject the transplanted liver. For the patient, side effects can include kidney damage, diabetes and osteoporosis.
At the world-renowned Institute of Liver Sciences – part of King’s College NHS Foundation Trust – my colleague Mr Andreas Prachalias and I have been part of the UK’s research into the auxiliary liver transplantation – a revolutionary approach to managing patients in severe acute liver failure.
In an auxiliary transplantation, the recipient’s damaged liver is partially removed and replaced with a cadaveric donor liver. The purpose is to allow the remainder of the patient’s own liver to recover and regenerate. Gradually, immunosuppression is withdrawn so that eventually, immunosuppressant medication can be stopped altogether.
For a patient in severe acute liver failure, finding a matching cadaveric donor liver can be the difference between life and death. Since medical legislation prevents cadaveric transplantations on international patients, options for those without immediate access to a highly specialised liver team in their home country can be extremely limited.
This was so for a 19 year-old Middle Eastern patient, who had been flown into HCA UK’s London Bridge Hospital for emergency treatment.
Having rapidly assembled our liver team from King’s College Hospital, we found a suitable living donor in the patient’s relative. We removed the right half of the donor’s liver and successfully grafted it onto the young patient.
This was the UK’s first ever example of an auxiliary partial orthoptic liver transplantation (APOLT) procedure with a living liver donor, and we believe it could have ground-breaking future implications for the wider field of liver transplantation.
For health insurers, we are also hopeful that this could point towards less complex – and costly – long-term management of patients post-transplantation.
Mr Parthi Srinivasan and Mr Andreas Prachalias are Consultant Surgeons specialising in Liver Transplantation and Hepato-Biliary Surgery at HCA Healthcare UK’s London Bridge Hospital and King’s College Hospital NHS Foundation Trust, London. They have performed over 2,000 liver transplant and complex HpB operations, including the UK’s first ever APOLT procedure using a living donor.
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