Liver transplants: 50 years of progress

Written by: Professor Roger Williams CBE
Published: | Updated: 06/05/2019
Edited by: Nicholas Howley

Since the first procedure was carried out just over 50 years ago, the UK has emerged as a world leader in liver transplants. In this article, early pioneer of liver transplants in the UK and towering figure in hepatology Professor Roger Williams CBE reflects on the progress over the last 50 years, and what’s in store for the future.

The last 50 years has seen incredible improvements in liver transplantation in the UK. Here is a summary of the state of liver transplantation today and what the future is likely to hold:

More transplants than ever

The past year alone has seen the number of transplants carried out in the UK increase to 1,014 with a 32% fall in the number of patients on the active waiting list. This was as a result of a greater number of organ donations.

Rates are likely to increase further with the passing of legislation allowing presumed consent in England, which is already in place in Wales. Another contributing factor is the use of extra corporeal machine preservation for improving the function of marginal organs. In 2017 some 16.3% of retrieved organs were not used on account of fatty change or ischemic damage.

Higher survival rates

Over the 50 years since the first successful cases in this country 1 the status of orthotopic (in normal position) liver grafts in adults has never been higher in terms of the quality of life obtained. Overall figures are currently running at over 90% one-year patient survival, with 5- and 10-year figures around 70%.

Rejection rates are low thanks to excellent immunosuppressive regimes based on Tacrolimus and Sirolimus, with a specific requirement for Prednisolone-only cases transplanted for auto-immune liver disease. Immunosuppression can only very occasionally be completely withdrawn, but most of the patients from 5 to 10 years onwards require only very low doses – reducing the likelihood of side effects from immunosuppressive medication.

New candidates for liver transplants

With the success of the direct antiviral agents against chronic HCV (hepatitis C) liver disease, the reduction in the number of transplants for this condition has meant an additional 600 organs being available for other transplant indications.

The places are likely to be taken up by an increased number of end-stage alcoholic cirrhosis related liver disease and NASH patients, often with complicating primary hepatocellular carcinoma (HCC). We are seeing this trend in the UK and worldwide as a result of increasing levels of alcohol consumption and rising obesity rates in adults.

However, these patients will not necessarily account for all newly available organ donation places. We are also likely to see some extension of transplantation to conditions that have not previously been considered suitable – including severely ill patients with “acute-on-chronic” liver failure. In these patients, the limited experience and data has shown remarkable survival rates compared with standard medical therapy.

References

  1. Calne RY, Williams R. Liver Transplantation in Man—I, Observations on Technique and Organization in Five Cases. Br Med J. 1968 Nov 30;4(5630):535-40.

By Professor Roger Williams CBE
Hepatology (liver specialist)

Professor Williams is the Director of the Institute of Hepatology, London and Medical Director of the Foundation of Liver Research, a UK-registered charity. He holds an honorary consultant hepatology position in King's College Hospital.

The Institute of Hepatology is an independent research institute funded and managed by the Foundation for Liver Research, a charity set up by Professor Williams in 1974. It has affiliate status to the King's College London and King's College Hospital. Between 1996 and 2010 Professor Williams established a major research institute at University College London and built a major clinical service in hepatology at University College Hospital. During that time he was also responsible for setting up the liver centre at The London Clinic. In his current position he remains close to the world-renowned Institute of Liver Studies at King's College Hospital which he started from scratch as a liver unit in 1966. For 30 years he was Director, building it to become one of the largest clinical and research liver units worldwide. He was responsible, together with Professor Sir Roy Calne, for the early pioneering start of liver transplants in the UK.

He is a fellow of the Academy of Medical Sciences, London and Royal College of Physicians where he was Clinical Vice President and Director of the International Office. He is a recipient of numerous honorary fellowships, medals and prizes including the American Society of Transplantation Senior Achievement Award in 2004, a Hans Popper Lifetime Achievement in 2008, the Distinguished Service Award of the International Liver Transplant Society in 2011, and in 2013 the Distinguished Achievement Award of the American Association for Study of Liver Disease. Since 2013 he has been Chairman of the Lancet Commission into Liver Disease in the UK which, with its body of experts and its annual reports and Parliamentary meetings, has addressed the main lifestyle causes of liver disease in the country, namely alcohol, viral hepatitis and obesity.

His main clinical and research interests are in acute and chronic liver failure, liver support devices, liver transplantation, complications or cirrhosis and management of viral hepatitis.

Professor Williams has wide experience of providing expert medical legal reports and can be contacted through his office at the Institute of Hepatology.

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