P73 Improved survival observed with liver transplant within first year of first emergency admission for chronic liver disease

<h3>Background</h3> Chronic liver disease (CLD) carries major morbidity and mortality burdens in the UK, with CLD deaths increasing substantially in recent decades. Many individuals with CLD present for the first time in emergency medical settings with already advanced disease, and 25% die within the first 60 days following index first emergency admission (FEA). Liver transplant (LT) is the only intervention with survival benefit in advanced CLD, however utilisation rates are very low. This analysis aimed to report survival outcomes among individuals who did and did not receive LT following FEA for CLD in England, it did not aim to estimate the causal effect of LT in this cohort. <h3>Methods</h3> National administrative hospital data were analyzed to construct a cohort of all adult patients in England with an FEA for CLD between 1 April 2012 and 31 March 2019. LT was ascertained in both hospital data and via linkage to NHS Blood and Transplant registry. Linkage to ONS death registrations enabled identification of death within first year following EA. Cumulative incidence of death from any cause throughout study duration was calculated, stratified by LT status. <h3>Findings</h3> The cohort was comprised a total of 82,402 individuals of whom 52,504 (63.7%) died during the study period, with a median time to death of 2.7 years. Only 0.7% of individuals underwent LT (n = 572, 95% CI 0.6% to 0.7%) within the first year following FEA. Of these, a minority (14.4%, n = 76) died following transplant. In contrast, the majority of individuals who did not undergo LT died. The difference in cumulative deaths across individuals who did and did not undergo LT was significant (figure 1, p &lt; 0.0001). The 5-year survival in individuals not undergoing LT was 40.8% (95% CI 40.6% to 41.2%), and was 88.2% individuals receiving LT (95% CI 85.1%, 90.8%). Patients undergoing LT are a highly selected group and systematic differences in their clinical and demographic characteristics likely account for some of the observed survival difference compared to non-LT patients. <h3>Conclusions</h3> Survival is very poor among individuals with CLD presenting acutely for the first time in an emergency hospital setting. Although survival was markedly higher in those receiving LT, fewer than 1% of patients received transplantation.