Access to liver transplant suboptimal

A dedicated session on liver disease and transplantation took place at the Irish Society of Gastroenterology (ISG) 2026 Summer Meeting.

Optimising access to liver transplantation through satellite centres was discussed by Dr Neil McDougall, Consultant Hepatologist, Royal Victoria Hospital, Belfast.

Dr McDougall outlined the current details of liver transplantation services in Northern Ireland, where patients are sent to the UK to receive a transplant, having been assessed and prepared locally, as well as improvements in access to liver transplantation in the region in the last 30 years.

The regional liver unit at the Belfast Health and Social Care Trust is a formal networked satellite transplant centre for King’s College Hospital, London, UK, providing tertiary hepatology services for all liver disease patients in Northern Ireland.

Significant work has been undertaken in recent years to expand hepatology outreach clinics across the North.

The liver transplant rate has improved substantially though it currently remains a little lower compared to mainland UK, Dr McDougall said.

Maintaining high transplant and five-year survival rates requires sustained effort and adequate resources, he acknowledged.

Dr McDougall noted that access to liver transplantation “is not equitable”.

Key barriers include socio-economic deprivation, geography, and distance from the local transplant centre, as well as an ongoing reluctance to put patients with alcohol-related cirrhosis forward for transplant.

Patient frailty and potential transport issues are also challenges.

The success of the Northern Ireland satellite model is an inspiration for Ireland, ISG audience members commented at the meeting.

Meanwhile, speaking during the same session, Dr Stephanie Rutledge, Consultant Hepatologist, St Vincent’s University Hospital, Dublin, discussed the treatment of alcohol-related liver disease (ALD).

Ireland has seen a rise in ALD mortality in recent years and it accounts for 20 per cent of liver transplants here.

While steroids play an important role in treatment of severe alcohol-associated hepatitis, with positive data on short-term survival, careful patient selection is key and not every patient will respond, she noted.

Dr Rutledge outlined the various infection risks and vulnerabilities in patients with ALD. She stressed that for patients with cirrhosis, ascites, and suspected spontaneous bacterial peritonitis, every hour delayed in performing a diagnostic paracentesis increases in-hospital mortality by 3.3 per cent.

“I think it is important to talk to our emergency department colleagues that, for our decompensated patients coming into hospital, they should have a diagnostic paracentesis done as soon as possible.”

She also highlighted the role of nutrition in these patients and emphasised the need for structured nutritional assessment and support.  “We do know that insufficient caloric intake is associated with higher mortality in alcohol-related hepatitis.”

 Looking at the role of biomarkers for alcohol use detection in ALD patients, Dr Rutledge said phosphatidylethanol (PEth) is the gold standard. A PEth blood test can identify moderate/heavy alcohol use in the preceding 28 days with 90 per cent specificity and 98 per cent sensitivity. It is unaffected by renal function, age, or BMI: “We use it to detect a relapse early and help a patient get back to abstinence.”

 Discussing the use of liver transplantation in this patient population, Dr Rutledge said the six-month alcohol abstinence ‘rule’ is being reassessed and moved to a three-month period in many centres.

“There is a move away from duration of abstinence to a nuanced patient-centred assessment of relapse risk.”

 The use of liver transplant in ALD is still suboptimal in Ireland, with high public stigma and a reluctance by some clinics to put these patients forward for it despite very significant data on the benefits of transplant for ALD patients and the dramatic reduction in mortality, Dr Rutledge said.