News Articles 151 - 160 of 160
The UK protocol for liver transplant in patients with severe acute alcoholic hepatitis (SAAH) has failed because it is too restrictive.
That's the opinion of Dr Alex Gimson, consultant hepatologist at Cambridge, who told delegates at the BLTG session the criteria must be expanded and the protocol widely publicised.
“Some protocol criteria were introduced to address concerns about the validity of the proposal, not because they identified a cohort with a high short-term mortality and a low risk of recidivism,” he said.
The SAAH transplantation programme was established in 2014, and the criteria set as patients aged less than 40 at their first presentation with any form of alcoholic disorder, who have not previously been told to stop drinking. They should have a Maddrey DF of more than 32 and a Lille score of more than 0.45.
There should be no sepsis or GIT haemorrhage, and hepatologists, alcohol specialists and the surgical and transplant teams should all agree on the course of action.
Just two patients have been referred under these criteria, one in September, 2014, and the other in February, 2015, yet neither have been treated. The first, a 27-year-old woman, was removed from the list when her condition improved, and the second, a 38-year-old man, died 48 days after being placed on the list.
“I feel the protocol is too restrictive,” Dr Gimson said. “I do not feel age is a good predictor, and I do not than that is right that it is about first presentation – it should be about decompensation. I don’t see why co-morbidities should be an exclusion.
“Why should criteria for selection for SAAH be qualitatively different from other indications? If there is a need, we should be assessing that need in the same way as others with non-alcoholic liver diseases are being assessed.”
In conclusion, he said the current SAAH protocol and implementation had failed.
“Patients with SAAH and poor short- term mortality are not adequately identified by the current prognostic scores,” he said.
In his closing recommendations, which he emphasised were personal opinions, he said the protocol should be relaunched to concentrate on similar factors to inactive ALD, then publicised widely.
Alcoholic liver disease is a world health problem, causing 493,000 deaths in 2010 – 0.9% of the total – but are transplant criteria too tough on drinkers?
Almost half, 47.9%, of all cirrhotic deaths are caused by alcoholic liver disease (ALD), and ALD-related cancer caused 80,600 deaths in 2010.
The figures are of no surprise, said Professor Mike Lucey, of the University of Wisconsin, during the Williams-Caine Lecture at conference today, where he asked if liver transplantation should be reserved for the abstinent.
He said: “Is a liver transplant a success if the patient is saved but returns to drink? Are we setting a higher standard? Does it not just have to cure the liver disease, but the alcoholism as well?
“These patients go through a more rigorous assessment than those in other indications.”
The answer lies in the interpretation of drinking behaviour, Prof Lucey said, adding that addiction specialists and transplant clinicians and surgeons speak different languages – and that divides them.
To illustrate this, he cited the primary outcomes of the Project MATCH study, from 1997, which were the number of days abstinent and number of non-drinking days.
“In our world, we talk about drinking or not drinking. We take a binary view while addiction specialists take a quantitative view.”
The data does show that relapse in transplanted ALD patients causes more rapid fibrosis and shortens life span, but only in the long term.
Prof Lucey said: “In order to see the shortened life-span, you need long-term follow up: of 10 years in some studies. If you only find problems 10 years later, should we be restricting patient access to a life-saving treatment because of that?”
The six-month rule, in which patients are only listed for transplant if they have remained abstinent for half a year, is still “alive and well” in the USA, Prof Lucey said.
“Many patients will drink again. Some will start early and stop, some will start and continue, and some will not stop for more than 1,000 days post-transplant.
“The addiction is not going to go away because of the transplant,” he said.
Concluding his talk, Prof Lucey said a paradigm shift was well overdue, and the goal of treatment should not be inducing abstinence, but improving the lives of people with ALD.
He said: “Liver transplant is only one part of the answer. We need to learn from addiction medicine and from patient experience.”
Responding to the government's statement on the alcohol consumption guidelines, Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance, said:
"We reiterate our support today for the alcohol consumption guidelines released in January 2016.
The public have the right to know about the harms associated with alcohol consumption, so that they can make informed choices about their drinking.
The latest evidence demonstrates that the risk associated with cancer increases with any amount of alcohol consumed, so there is no level of drinking which can be considered 'safe'. This evidence was not available when the guidelines were last reviewed and is partly why the low risk guidelines have been revised downwards by the four chief medical officers of England, Scotland, Wales and Northern Ireland.
I was part of the group advising the chief medical officers on the latest evidence, and can attest to the thoroughness and independence with which the guidelines were developed.
Thus far, the risks associated with alcohol consumption have been poorly communicated to the public. A study earlier this year, for example, demonstrated that nine in ten people are not aware of the link between alcohol and cancer.
To ensure the public has faith in these new guidelines, it is essential that the harms associated with alcohol are communicated clearly to healthcare professionals and consumers. This should be done via mandatory labelling of alcoholic products, and mass media campaigns developed by Public Health England."
For 20 years The PBC Foundation has been supporting people diagnosed and living with Primary Biliary Cholangitis.
On Sunday 11th September it is World PBC day when members and supporters will be involved in many charitable activities. One of these will start at the close of the BASL conference on the 9th of September as Robert Mitchell-Thain and colleagues start a 3 Peaks Walk to raise funds for the charity.
Robert would welcome the support of BASL members who would like to join them for any section of the walk, with Scafell on Friday 9th September, Snowdon on Saturday 10th September and finishing on World PBC day with Ben Nevis on Sunday 11th September.
If you want to join any leg of the event, contact Robert through email@example.com and if joining the event is not possible then please support their efforts through their Just Giving page; https://www.justgiving.com/fundraising/PBC-Foundation1 .
The Alcohol Health Alliance (AHA) campaigns for assurances that alcohol harm will be tackled in the government’s Life Chances Strategy.
August 2016: The AHA is working hard to ensure that the government’s forthcoming Life Chances Strategy will benefit all disadvantaged groups, including those suffering adverse consequences from alcohol, who make up a significant proportion of those needing support.
Click on the link > HERE to view their full briefing on the strategy.
If you have any questions please contact Laura McLeod, Policy and Advocacy Manager - Alcohol Health Alliance. Email - LMcLeod@alcoholconcern.org.uk or Tel: 0203 815 8930.
Statistics released by the Department for Transport today show that there has been no improvement in drink driving related deaths since 2010.
Campaigners, including the Campaign Against Drink Driving (CADD) and the Alcohol Health Alliance, are calling on the Government to lower the drink-drive limit in England and Wales in order to save lives and prevent serious injuries.
The statistics, published in a statistical release from the Department for Transport show that across the UK in 2014:
• Around 240 people were killed in drink driving related incidents, a figure unchanged since 2010.
• The number of drink driving casualties decreased slightly, as did the number of drink driving crashes.
• Only around 40% of the 1,310 people killed or seriously injured were drivers over the limit. Around 60% were other passengers, road users or pedestrians.
England and Wales currently have a high drink driving limit by international standards, set at 80mg alcohol/100ml blood. In December 2014, Scotland used its devolved powers to lower its limit to 50mg, and saw a 12.5% decrease in drink-drive offences in the first nine months of the new limit. The Northern Ireland Assembly is also in the process of lowering its drink driving limit too.
In June 2016, a Private Member’s Bill to lower the limit in England and Wales to 50mg, sponsored by Lord Brooke of Alverthorpe, successfully passed through all stages in the House of Lords, but ran out of parliamentary time to progress further. There are high levels of public support for this move, with a recent opinion poll citing 77% support for a lower legal limit.
There is also strong support from a wide range of high profile groups, including the police and emergency services, road safety charities, insurance firms and health bodies (see notes to editors for the full list of stakeholder supporters).
John Scruby, former police traffic officer and CADD campaigner commented:
“Drink driving has huge and life changing impacts, both for the individuals involved and their friends and families. The number of drink driving deaths on our roads has not reduced since 2010, the government needs to tackle this issue head on and lower the drink driving limit to make our roads safer.”
Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance, commented:
“It is deeply disappointing to see that deaths from drink driving have not gone down since 2010. The government have committed to improving road safety, and it is now time they looked at the evidence from home and abroad and lowered our legal limit.
“Not only would lowering the drink driving limit save lives and prevent life changing injuries, but it is consistently supported by the general public. Now is not the time for complacency, the government must take action to make our roads safer.”
Groups supporting a lower drink driving limit include:
• BRAKE, the road safety charity
• The Police Federation of England and Wales
• Fire Brigades Union
• College of Paramedics
• The Parliamentary Advisory Council for Transport Safety (PACTS)
• The Royal College of Physicians
• The Royal Society of Public Health
• Alcohol Concern
For any enquiries please contact: Laura McLeod | Policy and Advocacy Manager - Alcohol Health Alliance - LMcLeod@alcoholconcern.org.uk
Submit your application for the Andy Burroughs Young Investigator Award - Deadline Monday 8th August 2016
The Andy Burroughs Young Investigator Award will take place during the BLTG Transplant Day. The awardee will deliver a 30 minute lecture presenting their research on Tuesday 6th September.
This prize is awarded to young investigators, scientific or clinical, who are in training or within 2 years of taking up consultant positions (or equivalent).
The awardee will receive free registration to the meeting and £1,000.
To apply, please send one A4 sheet outlining the research and another A4 sheet listing up to 5 related publications.
Please send submissions to firstname.lastname@example.org before the deadline of 09.00hrs Monday 8th August 2016
As part of its mission to increase awareness of liver disease amongst parliamentarians and policy makers the Lancet Commission for Liver Disease has been working with Incisive Health to produce profiles of the burden of liver disease across England. The profiles have been customised to show data including Years of Life Lost, Mortality Rate and Hospital Admissions that is specific to each of the 533 parliamentary constituencies in England.
The details of your MP and name of their parliamentary constituency in your place of residence or work can be located here: http://www.parliament.uk/mps-lords-and-offices/mps .
BASL members are encouraged to use these profiles to secure a meeting with their local MP in order to continue to raise the profile of liver disease across parliament.
Zoledronic acid to reduce fractures in patients with alcoholic liver disease
The NIHR Health Technology Assessment (HTA) programme has reviewed the research requirements for the above topic, which was being considered by one of their Advisory Panels. The panels help the HTA programme to decide on which research topics are the highest priorities for the NHS.
The topic has been reviewed and discussed at a recent panel meeting and has been prioritised for funding. The topics prioritised for a call for applications are listed on the NIHR web site.
If you are interested in applying for funding, please visit the NIHR website > here .
Zoledronic acid to reduce fractures in patients with alcoholic liver disease - can be found in the list under HTA number 16/75.
The HTA programme encourages patients, the public, policy-makers and individuals working in the wider NHS to suggest topics for research. If you would like to submit a suggestion for research for consideration by the HTA programme or one of the other NIHR programmes managed by NETSCC, please go to our website http://www.nets.nihr.ac.uk/identifying-research .