‘ If a patient is considered to be at a relatively high risk of relapse then we would offer interventions to engage the patient in their recovery journey ... we rely upon support from local alcohol recovery services , even when people are abstinent .’
their health and independence returns . Recipients may need support from family , friends and local services during this period , and we work closely with patients and their support networks to ensure that they feel supported in their recovery . Longer term , liver transplant recipients can expect a good quality of life and people resume their usual activities .
Occasionally , people relapse in terms of their alcohol or drug use . It is our job to work with people around their relapse , explore their situation and contemplate their options for modifying their substance use . Over time , people ’ s focus shifts from their physical health to their psychological and social health , and it is our role to support them with achieving their goals . The liver transplant centres often provide peer support in the form of mentoring or group support to provide additional support from those who have been through transplantation .
As a group , the SMSLT work together to promote equitable access to liver transplantation . We contribute to audits , research , conferences and national working groups . We support each other with supervision and aim to provide improved access for people with alcohol-related liver disease to a life-saving treatment . For those who go through with transplantation the journey is extraordinary . Following a transplant , patients are required to take immunosuppressant medication every day for the rest of their life ( usually tacrolimus ). This stops the body from rejecting the transplanted liver but can mean the patient is more at risk of infections . The tacrolimus level is monitored closely as if it is too high this can cause toxicity and if it
Recommendations for referral for liver transplantation in alcoholassociated liver disease
1 . Assessment for liver transplantation should be made in a specialist multidisciplinary clinic
2 . Contraindications to liver transplantation include :
• Active ongoing alcohol use
• Drinking alcohol on the waiting list and during the period of transplant evaluation
• A history of repeated non-adherence with advice to abstain from alcohol 3 . Relative contraindications to liver transplantation .
• Evidence of apparently deliberate poor adherence to medication or clinical care including frequent missed medical appointments .
• Inadequate patient support or social network where this is likely to undermine the patient ’ s ability to maintain abstinence and engage with treatment .
• Evidence of severe and enduring mental health problems that , in the opinion of the transplant team , will undermine the likelihood of a good clinical outcome and graft survival despite optimal psychiatric input .
• Two or more episodes / periods of alcohol relapse within two years despite clinical advice to abstain and in the knowledge of harm .
• A recent history of cross-dependence ( stopping one substance of addiction but replacing it with another ).
• Refusal to engage in a smoking cessation programme following transplantation .
is too low this can cause rejection which can be fatal . Patients must therefore attend regular liver clinic appointments and have regular blood tests .
It is important for patients to have a supportive network of friends , family and local services . We work closely with patients and their support networks to formulate a relapse prevention and recovery plan . We work as part of a multidisciplinary team including hepatologists , surgeons , dieticians , physiotherapists and transplant coordinators – some centres also have addiction psychiatrists whereas other services are nurse-led .
Stephen Barnes / Medical / Alamy
TIM ’ S STORY
I WAS REFERRED TO THE LIVER UNIT and saw a hepatologist , dietician and substance misuse nurse specialist . The support I received was amazing and they treated me with kindness and compassion . I worked so hard as I wanted to prove that I was taking their advice seriously . They offered me different options and tailored the support to suit me . We settled for an online recovery programme with online meetings , which went well . The assessments were good and all explained in layman ’ s terms . After the second assessment , I knew I was dying but there was a problem with my blood tests . That was me over and I almost gave up . However the hospital phoned me and said there was still a chance , and over the next three months I worked so hard with them . This brings me to four and a half months post-transplant , feeling like a new man and applying for jobs , all down to the support I received .
Charlie Parker is an addiction psychiatry clinical nurse specialist and SMSLT chair , Queen Elizabeth Hospital Birmingham ; charlotte . parker @ uhb . nhs . uk . Ian Webzell is alcohol and substance misuse clinical nurse specialist at King ’ s College Hospital
Written on behalf of SMSLT
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