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PTU-087 Specialist MDT clinic management improves acceptance rates and post-transplant relapse in patients with ArLD

Introduction Alcohol-related Liver Disease (ArLD) is the most common indication for liver transplantation (LT) in the UK (30%) but many patients are deemed physically or psychologically unsuitable at the time of LT assessment and post-LT alcohol relapse rates remain high (1–2% Kawaguchi et al. 2014). A specialist high intensity ArLD clinic was established to optimise patient’s pre-LT assessment from a medical, addiction, psychological and nutritional perspective and evaluate high risk patients assessed for LT within a specialist MDT clinic environment. The clinic comprises of 2 Transplant Hepatologists, addiction psychiatry specialists, liver dietician & researchers. The aim was to review the impact of the high intensity clinic programme in patients transplanted for complications of ArLD cirrhosis. Methods Data was reviewed retrospectively from all patients attending clinic from inception, 25/5/2016- 31/9/2018. Electronic notes and alcohol addictions/transplant databases were interrogated. Patients were contacted anonymously (independent from health practitioners) by Psychology researchers for follow-up psychological data. Results 261 patients were seen, 247 (seen pre-LT) were included for analysis (173M: 74F), mean age 54y (SD±19.65), UKELD=53 (SD±5.63). 124 (50%) were presented in the transplant listing meeting, 71 (57.25%) accepted. 46 underwent LT at time of analysis, median waiting list time=39d [range 3–373]. 11/247 attendees (4%) had documented relapse within the programme pre-LT. 54/247 (21.9%) were referred to the high intensity clinic after being turned down by the transplant listing meeting, considered physically or psychologically unsuitable. Of these, 59.3% were re-presented after further intervention and subsequently listed. Of all attendees, 54 deaths (21.9%) were recorded on follow-up (2 on the LT waiting list & 4 post LT). Follow-up questionnaire completion rate was 78% (32/41) demonstrating high levels of patient engagement. Patient satisfaction with the clinic was high. Median follow-up post-LT was 13mo [range –8.4]). Post-transplant relapse in this high risk group managed in the high intensity clinic was 0/46 (0%)–vs 6/49 (12.2%, p<0.05) in a historical post-LT ArLD group (201–9) not seen in the high intensity clinic (n=49 contacted from 68 transplanted, 72%). Conclusion The High Intensity MDT clinic is an effective clinical environment for treating high risk patients and managing their physical and psychological risk factors. Specialist addiction-focussed MDT management enables patients who were initially deemed unsuitable for transplantation to be listed for surgery and is shown to significantly reduce short term relapse in this cohort of patients.