Guidelines for liver transplantation for patients with non-alcoholic steatohepatitis.

GUIDELINE DEVELOPMENT Non-alcoholic steatohepatitis (NASH) is an increasing cause of liver disease necessitating liver transplantation. In patients with advanced NASH, there are often coexistent clinical issues that impact on the outcome of liver transplantation. There are no guidelines for the assessment and management of patients with NASH undergoing liver transplantation. A group was therefore invited by the Council of the British Transplant Society (BTS) to prepare guidelines for the management of NASH before and after liver transplantation. The guideline is approved by the British Society of Gastroenterology, the British Association for the Study of Liver and NHS Blood and Transplant. The first draft was written by Dr P N Newsome (senior lecturer and consultant hepatologist, Liver Unit, University Hospital Birmingham NHS Foundation Trust) in Autumn 2010 with contributions from the following guideline group: Dr Peter Henriksen (consultant cardiologist and honorary senior lecturer, Edinburgh Heart Centre, NHS Lothian, University Hospitals Division), Professor C P Day (Professor of Liver Medicine, Institute of Cellular Medicine, Newcastle University), Dr D Thorburn (consultant hepatologist, Liver Unit, Royal Free Hospital, London), Mr D F Mirza (consultant hepatobiliary and transplant surgeon, Liver Unit, University Hospital Birmingham NHS Foundation Trust), Dr J W Ferguson (consultant hepatologist and honorary senior lecturer, Liver Unit, University Hospital Birmingham NHS Foundation Trust), Dr G Auzinger (consultant intensive care medicine, Liver Intensive Therapy Unit, King’s College Hospital London NHS Foundation Trust), Dr M Allison (consultant hepatologist, Liver Unit, Department of Medicine, Cambridge University Hospital NHS Foundation Trust), Dr J W Tomlinson (reader in endocrinology, Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham), H Manley (British Liver Trust), Dr K J Simpson (senior lecturer in hepatology, University of Edinburgh and honorary consultant physician, Scottish Liver Transplantation Unit, Royal Infirmary Edinburgh), Professor S G Hubscher (Leith Professor and Professor of Hepatic Pathology, University of Birmingham, and consultant histopathologist, University Hospital Birmingham NHS Foundation Trust), Dr C Millson (consultant hepatologist, St James’s University Hospital, Leeds), Dr J Oben (Wellcome Trust senior lecturer and consultant hepatologist, University College London, Centre for Hepatology, Royal Free Hospital, London), Professor J M Neuberger (Associate Medical Director for Organ Donation and Transplantation, NHS Blood and Transplant and honorary consultant physician, Queen Elizabeth Hospital, Birmingham), Dr P J McKiernan (consultant paediatrician, Liver Unit, Birmingham Children’s Hospital) and Dr J I Wyatt (consultant histopathologist, St James’s University Hospital, Leeds). This followed a systematic review of the literature using retrieval from electronic databases and reading suggestions from colleagues. There was also significant input from the British Liver Trust across the whole document as well as the section on patient perspective. The document was revised in the autumn and winter of 2010, principally by Dr P N Newsome and Dr P A Andrews (Chair, BTS Standards Committee). The last date of literature review was November 2010. A draft version was circulated to members of the BTS Council and placed on the BTS website for comment in March 2011 (http://www.bts.org.uk/ transplantation/standards-and-guidelines/). The final version was revised in the light of comments received in April 2011. These guidelines represent consensus opinion from experts in the UK in the fields of hepatology, transplantation and related disciplines. They represent a snapshot of the evidence available at the time of writing. It is recognised that recommendations are made even when the evidence is weak, and indeed much of the evidence quoted is level C (consensus opinion) and so this document in many parts serves a consensus statement rather than clinical guidelines. However, as there is clear evidence in many sections and given that this document has been endorsed by the British Society of Gastroenterology, the British Association for the Study of Liver, BTS and UK and Ireland Transplant, it is felt the paper states a guideline. Although it is believed that the information presented is a fair summary of current evidence and best practice, neither the authors nor the BTS can be held responsible for any errors or omissions. The guidelines are not designed to be proscriptive, nor to define a standard of care. Doses of prescribed drugs should always be checked by the responsible clinician according to the relevant information provided by the manufacturers of the drugs. It is anticipated that these guidelines will be revised in 2015. Department of NIHR Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Birmingham, UK Department of Medicine, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK SW Thames Renal and Transplantation Unit, London, UK Institute of Liver Studies, King’s College Hospital, London, UK Liver Unit, University of Newcastle, Newcastle, UK Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh, UK Department of Pathology, University of Birmingham, Birmingham, UK British Liver Trust, Ringwood, UK Liver Unit, Birmingham Children’s Hospital, Birmingham, UK Liver Unit, St James’s University Hospital, Leeds, UK NHS Blood and Transplant, Bristol, UK Centre for Hepatology, University College London, London, UK Department of Hepatology, University of Edinburgh, Edinburgh, UK Liver Unit, Royal Free Hospital, London, UK Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, Birmingham, UK Department of Pathology, St James’s University Hospital, Leeds, UK