• Cynthia Tsien, Huey Tan, Sowmya Sharma, Naaventhan Palaniyappan, Pramudi Wijayasiri, Kristel Leung, Jatinder Hayre, Elizabeth Mowlem, Rachel Kang, Peter J Eddowes, Emilie Wilkes, Suresh V Venkatachalapathy, Indra N Guha, Lilia Antonova, Angela C Cheung, William Jh Griffiths, Andrew J Butler, Stephen D Ryder, Martin W James, Guruprasad P Aithal, and Aloysious D Aravinthan.
• The Ottawa Hospital, Ottawa, Canada, University of Ottawa, Ottawa, Canada and Ottawa Hospital Research Institute, Ottawa, Canada.
• Clin Med (Lond). 2021 Jan 1; 21 (1): e32e38e32-e38.

IntroductionIncreasing rates of liver transplantation and improved outcomes have led to greater numbers of transplant recipients followed up in non-transplant centres. Our aim was to document long-term clinical outcomes of liver transplant recipients managed in this 'hub-and-spoke' healthcare model.MethodsA retrospective analysis of all adult patients who underwent liver transplantation between 1987 and 2016, with post-transplant follow-up in two non-transplant centres in the UK (Nottingham) and Canada (Ottawa), was performed.ResultsThe 1-, 5-, 10- and 20-year patient survival rates were 98%, 95%, 87% and 62%, and 100%, 96%, 88% and 62% in the Nottingham and Ottawa groups, respectively (p=0.87). There were no significant differences between the two centres in 1-, 5-, 10- and 20-year cumulative incidence of death-censored graft-survival (p=0.10), end-stage renal disease (p=0.29) or de novo cancer (p=0.22). Nottingham had a lower incidence of major cardiovascular events (p=0.008).ConclusionAdopting a new model of healthcare provides a means of delivering post-transplant patient care close to home without compromising patient survival and long-term clinical outcomes.© Royal College of Physicians 2021. All rights reserved.

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