Adult liver transplantation for the advanced clinical practitioner: an overview

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.