Barber K, Madden S, Allen J, Collett D, Neuberger J, Gimson A Elective liver transplant list mortality: development of a United Kingdom end-stage liver disease score. Transplantation. 2011; 92:(4)469-476

BC Renal Agency. Major drug interactions with cyclosporine and tacrolimus. 2016. (accessed 26 September 2022)

Chelala L, Kovacs CS, Taege AJ, Hanouneh IA Common infectious complications of liver transplant. Cleve Clin J Med. 2015; 82:(11)773-784

Choudhary NS, Saigal S, Bansal RK, Saraf N, Gautam D, Soin AS Acute and Chronic Rejection After Liver Transplantation: What A Clinician Needs to Know. J Clin Exp Hepatol. 2017; 7:(4)358-366

Clouston A, Hubscher S Transplantation Pathology, 7th edn. In: Burt A, Ferrell L, Hübscher S Philadelphia (PA): Elsevier; 2018

Craig EV, Heller MT Complications of liver transplant. Abdom Radiol (NY). 2021; 46:(1)43-67

Della-Guardia B, Almeida MD, Meira-Filho SP Antibody-mediated rejection: hyperacute rejection reality in liver transplantation? A case report. Transplant Proc. 2008; 40:(3)870-871

Cleveland Clinic Centre for Continuing Education. Post-liver transplant management. 2010.

Fricker J Thomas Starzl. BMJ. 2017; 357:j1806-j1806

Global Observatory on Donation and Transplantation. Total liver data (charts and tables). 2022. (accessed 3 October 2022)

Joint Formulary Committee. Tacrolimus. British National Formulary 82. 2021. (accessed 26 September 2022)

Medicines and Healthcare products Regulatory Agency. Oral tacrolimus products: reminder to prescribe and dispense by brand name only. 2017. (accessed 26 September 2022)

Millson C, Considine A, Cramp ME Adult liver transplantation: a UK clinical guideline – part 1: pre-operation. Frontline Gastroenterol. 2020a; 11:(5)375-384

Millson C, Considine A, Cramp ME Adult liver transplantation: UK clinical guideline – part 2: surgery and post-operation. Frontline Gastroenterol. 2020b; 11:(5)385-396

Morrissey PE, Flynn ML, Lin S Medication noncompliance and its implications in transplant recipients. Drugs. 2007; 67:(10)1463-1481

Mozayani A, Raymon L Handbook of drug interactions a clinical and forensic guide.New York (NY): Springer; 2012

Mukherjee S, Mukherjee U A comprehensive review of immunosuppression used for liver transplantation. J Transplant. 2009; 2009:1-20

Neuberger J, Gimson A, Davies M Selection of patients for liver transplantation and allocation of donated livers in the UK. Gut. 2008; 57:(2)252-257

NHS Blood and Transplant. Policy POL195/11. Liver transplantation: selection criteria and recipient registration. 2019a. (accessed 26 September 2022)

NHS Blood and Transplant. Policy POL196/7. Deceased donor liver distribution and allocation. 2019b. (accessed 26 September 2022)

NHS Blood and Transplant. Organ and tissue donation and transplantation activity report 2021/22. 2022a. (accessed 26 September 2022)

NHS Blood and Transplant. Calculators. Liver. 2022b. (accessed 27 September 2022)

NHS website. Health A to Z: Liver transplant. Assessment. 2022. (accessed 3 October 2022)

Pillai AA, Levitsky J Overview of immunosuppression in liver transplantation. World J Gastroenterol. 2009; 15:(34)4225-4233

Schreibman I, Regev A Recurrent primary biliary cirrhosis after liver transplantation--the disease and its management. MedGenMed. 2006; 8:(2)

Tripathi D, Stanley AJ, Hayes PC Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension. Gut. 2020; 69:(7)1173-1192

Ueda Y, Kaido T, Okajima H Long-term prognosis and recurrence of primary sclerosing cholangitis after liver transplantation: a single-center experience. Transplant Direct. 2017; 3:(12)

University of Edinburgh. Transplant benefit score calculator. 2018. (accessed 26 September 2022)

van Gelder T How cyclosporine reduces mycophenolic acid exposure by 40% while other calcineurin inhibitors do not. Kidney Int. 2021; 100:(6)1185-1189

Adult liver transplantation for the advanced clinical practitioner: an overview

13 October 2022
Volume 31 · Issue 18


Liver transplantation (LT) is a major surgical undertaking but, in a carefully selected population, it provides excellent outcomes in terms of prolongation of life and improvements in quality of life. This article outlines the processes of referral, assessment, operative course and post-transplant complications of LT, in the UK context. Specific consideration is also given to immunosuppressive medications and considerations around their prescription. The role of the advanced clinical practitioner (ACP) in primary or secondary care may focus on identifying potential candidates for transplantation and ensuring timely discussion and referral. Thus, a familiarity with eligibility criteria, and where to access this information, is important for all ACPs. Additionally, the increasing numbers of transplants performed in the UK mean that there is a large population of post-transplant patients in the wider community. These patients may present to healthcare services with a variety of issues relating to their LT, where early recognition and treatment has the potential to have major impacts on patient, or graft, function and longevity. Due to this, early discussions with specialist transplant centres is advised.

Since the first successful liver transplant (LT), performed by Thomas Starzl in 1967 (Fricker, 2017), LT has become an accepted and effective treatment for a select cohort of patients with end-stage chronic liver disease, or other potential indications. Although never a routine procedure, more than 900 LTs are performed annually in the UK (NHS Blood and Transplant (NHSBT), 2022a), with approximately 36 000 worldwide per year (Global Observatory on Donation and Transplantation, 2022). Despite this level of activity, a mismatch between supply and demand persists, with 400 to 500 patients awaiting LT at any one time in the UK (NHSBT, 2022a).

Organisation of transplants in the UK is regional, with post-transplant patients normally followed up in local centres. If unwell, they will likely present to primary or secondary care services prior to referral on to tertiary transplant units if indicated. Excellent, and continuously improving, survival rates post-transplant mean that there is a large population of LT recipients within the general community. It is therefore important that advanced clinical practitioners (ACPs) are aware of some of the key issues associated with the transplant assessment process, the appropriate clinical management of transplant patients and develop an understanding of some of the specific complexities discussed in this article.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content