Dr Palak Trivedi (Inflammatory Bowel Disease/Liver)

Institution: University of Birmingham
Title: Inflammatory Bowel Disease (IBD) Care Delivery Following Liver Transplantation for Primary Sclerosing Cholangitis (PSC)
Grant: £10,000 : Core-Dr Falk SpR Trainee Audit/Quality Improvement Award 2017
Project start date: 19th January 2018
Completion date: 19th September 2018

Summary:Primary Sclerosing Cholangitis (PSC) is a liver disease with no known cure. Liver transplantation is the only treatment that improves survival for patients. Whilst PSC is rare, it however accounts for 10 – 15% of all liver transplants in the United Kingdom (UK) and is the main reason for needing a liver transplantation in many countries across Europe.

Unfortunately, most people with PSC also develop inflammation of the gut (colitis, a type of Inflammatory Bowel Disease) and despite the fact that patients are often of a young age when diagnosed (<45 years old), the combination of both conditions (PSC and colitis) significantly increases the risk of bowel cancer. The colitis that is associated with PSC is easier to treat before a liver transplantation is needed, but becomes difficult to manage afterwards. In addition, if the colitis is not treated properly, it may damage the newly transplanted liver, causing PSC to return or problems with the new liver’s blood supply.

This project will study the way that colitis is managed in hospitals following liver transplantation, including how good the checks for bowel for cancer are performed at present, as well as the level and adequacy of information provided to patients. Dr Trivedi also hopes to find out which way of treating colitis gives the best results for the patients and for their liver transplant, with the aim of understanding how gut inflammation leads to liver damage.

This project is an audit and it will review three main aspects of practice and service provision:

  • Dr Trivedi will visit individual hospitals to review how they deliver colonoscopy for screening and surveillance for colitis and bowel cancer in patients with PSC/colitis who have undergone liver transplantation.
  • Practice will also be audited for timely review of IBD activity by a specialist gastroenterologist, for quality of care delivery and for treatment strategy employed when colitis flares occur after liver transplantation.
  • A dedicated patient survey will be carried out to determine the level of information and awareness provided to patients, with regard to how IBD behaviour may change after liver transplantation.

Dr Trivedi will access the data of over 400 patients with PSC who have undergone liver transplantation, from six liver transplant centres within the UK.

This project will be the first, nationwide audit of the care delivery for colitis in a group of patients with PSC who have received a liver transplantation. The audit will provide a framework that can be then used to decide what the best treatment approach is for these patients. Dr Trivedi also hopes that treating colitis more effectively in these patients may protect against transplant related complications, and provide a novel approach to prolong the life of the liver transplant.