{
  "abstract": "Introduction Liver transplant (LT) remains the only curative treatment for decompensated liver disease, acute liver failure and hepatocellular carcinoma. Graft complications and long-term immunosuppression are associated with significant morbidity and mortality. Mean average survival at ten years post-liver transplant is 70%, with the main causes of mortality beyond five years being sepsis, de novo malignancy and cardiovascular disease. 1 There is not a nationally-agreed approach to the long-term monitoring and follow-up of long-term LT patients. Here, we present a quality improvement project undertaken at a single non-transplant centre to define current practice, aiming to standardise and improve the monitoring of these patients.Methods All patients who had a LT survived over five years before 21/11/2025 and were under active follow-up at the centre were included. Routine clinical data (including demographics, long term medications, frequency of investigations and comorbidities) was collated and analysed.Results 171 patients were identified, with analysis ongoing (particularly for spoke sites). At the time of analysis, the average age was 55 years, 56% were male, the average number of years post-transplant was 11.6 and 13% of patients were transplanted aged under 18. 43% of patients remained on dual immunosuppression and 9% had had a subsequent LT. In the last six months, the proportion of patients who had had their lipids, renal function and HbA1C measured was 76%, 89% and 74% respectively. Patients were infrequently (56%) referred for bone densitometry post-transplant, yet 42% of patients who were investigated had a diagnosis of osteoporosis or osteopenia. 18% were diagnosed with a de novo malignancy post-transplant - in 50% of cases this was skin cancer. Routine skin cancer education and dermatology reviews were not offered to any patients.Conclusions Long-term LT patients are at risk of a number of comorbidities, including malignancy, cardiovascular disease and sepsis. Results to date have shown patients are regularly screened for cardiovascular risk factors, but antiplatelet or anticoagulation therapy is not ubiquitous and 43% remain on dual immunosuppression despite only 18% having high-risk of rejection indications. Screening for dermatological malignancy and osteoporosis is infrequently done and provides an opportunity to improve local current practice. The absence of nationally-agreed standards for long-term follow-up care for LT patients has created a heterogenous approach. A more nationally-agreed, evidence-based approach to long-term post-LT care may result in improved outcomes and long-term survival in this emerging population.Reference Palaniyappan N, et al. Long-term outcomes (beyond 5 years) of liver transplant recipients – a transatlantic multicenter study. Liver Transplantation 2024;30(2):170–194.",
  "authors": [
    {
      "affiliations": [
        "The Nottingham Liver Network, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom"
      ],
      "name": "Rachel Perry"
    },
    {
      "affiliations": [
        "The Nottingham Liver Network, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom"
      ],
      "name": "Sarah Brojaka"
    },
    {
      "affiliations": [
        "The Nottingham Liver Network, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom"
      ],
      "name": "Ritvik Kumaran"
    },
    {
      "affiliations": [
        "The Nottingham Liver Network, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom"
      ],
      "name": "Mariya Mathew"
    },
    {
      "affiliations": [
        "The Nottingham Liver Network, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom"
      ],
      "name": "Eslam Shebab"
    },
    {
      "affiliations": [
        "The Nottingham Liver Network, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom"
      ],
      "name": "Yugan Subramaniam"
    },
    {
      "affiliations": [
        "The Nottingham Liver Network, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom"
      ],
      "name": "Robert Scott"
    }
  ],
  "title": "P126 A quality improvement project to improve and standardise the monitoring of long-term liver transplant patients (over five years)",
  "uid": "27bce575-4941-56ee-b8ad-4521376d5ec2"
}