P124 Allied health professionals are essential for facilitating initial evaluation and optimisation of patients for liver transplantation

<h3>Background</h3> Assessment for Liver Transplantation (LT) involves a multi-disciplinary approach. Allied health professionals (AHP) use evidence-based methods to assess risk and suitability for LT, providing individualised advice for candidacy optimisation. <h3>Method</h3> A multidisciplinary assessment clinic (MAC) at our centre (physiotherapist, dietician, specialist alcohol nurse, hepatologist and anaesthetist) provides evaluation of patients referred for consideration of LT where concerns around frailty, fitness and alcohol history are raised. Data were collected on sequential patients seen in the MAC between June 2022 and May 2023, including evaluation (hand grip strength (HGS), Liver frailty Index (LFI), alcohol relapse risk), outcome and where appropriate subsequent listing outcome. <h3>Results</h3> Seventy-six patients were seen (50-male), median age 58-years. Aetiology was alcohol (54%), MASLD (16%), Autoimmune (16%), viral (6%) and other (8%). Indications for assessment were decompensated cirrhosis (82%), HCC (5%), variant syndromes (13%). Of the patients seen in the MAC, 26/76 (29%) did not see an AHP. Reasons included no indication, absolute contraindication or advanced palliative stage of disease. These 26 patients did not proceed on a LT pathway. Fifty patients thus underwent full evaluation by AHP’s in the MAC following which 22/50 (44%) were booked directly for LT workup of which 19/22 (86%) proceeded to be listed for LT. Between initial MAC and LT workup, LFI and HGS improved significantly, with mean improvement of -0.43 (p&lt;0.05) and 8.8KG (p&lt;0.05) respectively. Twenty-eight patients were deemed to be either too frail or too high risk from an alcohol perspective to proceed to LT work up. After a median time of 17-weeks (range 5–46 weeks), 36% (n=10/28) improved sufficiently to proceed to LT workup, of which 7/10 were subsequently listed. LFI and HGS improved significantly over this period with mean improvement of -0.45 (p&lt;0.05) and HGS 9.8KG (p&lt;0.05) respectively, and subjective alcohol relapse risk reduced. <h3>Conclusion</h3> This data highlights that a MAC approach allows optimisation and identification of patient for LT as evidenced by, identification and optimisation of those patients suitable for immediate LT work up resulting in high listing proportion (86%); optimisation to facilitate listing of patients deemed initially to be too frail for work-up (35%) and finally aid identification of those patients in which a full LT work-up would be futile (29%). The clinic thus ensures timely and appropriate management plans, intensive optimisation and cost saves on futile LT work up. Our centre feels this should be considered the gold standard for candidacy for LT work up.