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Hepatology and liver transplant services at the Royal Free Hospital
Liver services including inpatient care, outpatient appointments, endoscopy procedures, diagnostic tests, medication dispensing and clinical trial appointments are provided at the Royal Free Hospital. Additional services may be provided in some community locations and at other hospital sites.
The Sheila Sherlock Liver Centre, based at the Royal Free Hospital, is one of the UK’s leading centres for treating liver disease and has been established for more than 50 years.
As well as manging chronic liver damage, acute liver failure, liver cancer and providing pre and post-liver transplant care, we treat a range of other liver problems, including:
- alcohol-related liver disease
- metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as fatty liver disease
- viral hepatitis
- genetic liver conditions
- immune-mediated liver diseases
Our highly skilled and well reputed team, supported by the most up-to-date equipment, work with other specialist teams across the Royal Free Hospital to provide liver treatment services. These include:
- liver biopsies
- endoscopies
- liver transplants
- hepatitis treatment and support
- alcohol treatment and support
Referrals for outpatient care are made by GPs via an electronic referrals service (the NHS e-Referral Service (eRS). After receiving the referral, it will be triaged and details of outpatient clinic appointments will be sent directly to the patient.
Referrals for outpatient care from other hospitals are made by email to a daily monitored email inbox and the referrals will be triaged and appointment details sent to the patient.
Urgent inpatient care or urgent clinical advice can be sought by clinicians 24 hours a day, by contacting the on-call hepatology SpR through the Royal Free Hospital switchboard on 020 7794 0500.
Hepatology referral form - external hospitals only
To be used by external referring hospitals only. GPs must use ERS.
Research and innovation are central at the Sheila Sherlock Liver Centre.
Our liver specialist team works in partnership with University College London, one of the 10 leading research universities in the world.
The type of liver disease treatment we provide will depend on the type and seriousness of the liver conditions our patients have.
Liver biopsy, scan, and endoscopy
We use specialist scanning and endoscopy (a tiny camera that is used to see inside the body) equipment to find out the level of liver damage you are experiencing.
Our liver specialist team will often need to perform a liver biopsy to understand the type of liver disease and its cause and monitor the progress of your liver disease treatment.
Reducing liver damage and enhancing liver repair
The preferred method of fatty liver treatment by our liver specialists is drug therapy to enhance insulin sensitivity, reduce metabolic risks or reduce activation of cells which can cause further liver damage. Drug therapy can also enhance liver repair.
Alcohol and hepatitis treatment
Where our patients require hepatitis or alcohol treatment or support, our liver specialist team will work with other Royal Free Hospital specialist doctors, nurses, and psychologists to provide the latest therapies and appropriate care.
Fibrosis and cirrhosis treatment
Treatment for fibrosis of the liver depends on your specific circumstances.
Our liver specialists will go through this with you and recommend drug therapy or, in some cases, liver surgery, depending on the extent of the liver damage you've suffered.
Cirrhosis is a progressive liver disease, and damage sustained to the liver is irreversible.
To avoid further liver damage, we usually provide vitamin supplements, advice and help with healthy eating and proper nutrition, as well as promoting the avoidance of alcohol.
In severe cases, we may suggest a liver transplant.
The Royal Free Hospital is one of seven UK centres receiving referrals and performing transplants for patients from a wide geographical area. Patient outcomes are excellent when compared nationally, with one-year survival at more than 94%, and five-year survival at 86%.
Patients require liver transplants for a variety of reasons including acute liver failure, cirrhosis and its complications, and liver cancer.
The Royal Free Hospital runs a dedicated outpatient liver transplant assessment clinic. We can perform a comprehensive assessment of a patient’s candidacy for liver transplant.
Alternatively, the hospital provides outreach services to several centres (Bournemouth, Bristol, Cardiff, Frimley, Oxford, and Portsmouth), where a transplant physician reviews patients in their local hospital alongside their local team.
It is our target to review all outpatient referrals for liver transplant within two to four weeks, depending on urgency. More urgent cases or cases of acute liver failure will be transferred to the hepatology ward or the liver intensive care unit for urgent inpatient evaluation.
After initial assessment patients undergo a formal assessment for transplantation, which takes place at the Royal Free Hospital. The majority are done over two days with patients (and a chosen next of kin) staying in local accommodation provided by the hospital.
The purpose of the assessment is to understand in detail your general health, liver health and psychological and social wellbeing, to determine if a liver transplant is the best form of treatment for you.
The average wait for a liver transplant in the UK varies depending on your blood group, indication for liver transplant and severity of liver disease.
Patients on the liver transplant waiting list are reviewed regularly either at the Royal Free Hospital or at a dedicated outreach centre.
This is to ensure patients remain suitable for a liver transplant with respect to their fitness, nutrition, and suitability for the transplant.
Following the liver transplant, patients are initially sited on the Liver Intensive Care Unit, located on the 4th floor, and when clinically stable are transferred to 9 North, the hepatology ward.
The length of stay following a liver transplant operation varies, however, the average length of stay at the Royal Free Hospital is two weeks.
Following discharge, patients are initially seen weekly in the post-liver transplant clinic with the interval between appointments increasing as a patient’s clinical condition stabilises.
Liver transplant patients are kept under life-long follow-up by their transplant centre.
Our pancreatobiliary medicine department provides advanced endoscopy service for pancreas and biliary tree disorders, along with other gastrointestinal conditions.
As the regional tertiary referral centre for HPB surgery and liver transplantation, we provide crucial support for these services. You may be brought to the Royal Free Hospital for the day to undergo a procedure which your local hospital is not able to provide.
Aside from advanced interventional endoscopy, PB medicine clinics run weekly in our outpatient department. We receive referrals for both meetings from centres across north central London and the wider region.
We offer:
- endoscopic retrograde cholangiopancreatography (ERCP)
- endoscopic ultrasound (EUS)
- cholangioscopy/SpyGlass
- electrohydraulic lithotripsy (EHL)
- pancreatic ERCP/pancreatoscopy
- pancreatic cystogastrostomy
- lumen apposing metal stent insertion (LAMS) for internal drainage of pancreatic or other collections
- EUS-guided biliary drainage
- EUS-guided gastro-enterostomy
- enteric stenting
- coeliac axis nerve block
General practice
Please refer patients via the NHS e-Referral Service. Please enclose results of any recent imaging and a full recent bloodwork.
Secondary care referrals
For outpatient assessment, email your referral letter to rf-tr.
For urgent inpatient referrals, the PB medicine department has an in-hours fellow supported by a consultant available to discuss referrals.
Please contact the Royal Free Hospital switchboard on 020 7794 0500 and ask for the ERCP fellow.
NAFLD is the accumulation of too much fat in the liver. It is closely linked to being overweight, as well as conditions such as type 2 diabetes, high blood pressure and high cholesterol levels.
Some people with NAFLD may develop inflammation and scarring of the liver. In a small number of people, this can lead to liver cancer or liver failure.
NAFLD services
- A multidisciplinary service for patients.
- Dietetic support by a dedicated liver dietitian who provides bespoke consultations for patients in need of dietetic advice.
- Associated conditions such as type 2 diabetes and high cholesterol. Patients might see all specialists on the day of their clinical appointment.
The clinic is supported by specialist multidisciplinary teams including histopathology, radiology and interventional radiology and is closely linked to the Royal Free Hospital liver transplant service.
Research
We offer a portfolio of clinical trials and a range of research projects exploring the causes, management, and outcomes of NAFLD and its impact on patients’ lives.
Patients may be eligible to take part in these studies to contribute to research, donate samples (such as blood) to a research archive (biobank), and potentially to access novel treatments in clinical trials.
Links
- Read information about NAFLD on the British Liver Trust website.
- Guidelines for patients developed by the European Association for the Study of the Liver (EASL).
Advanced chronic liver disease is the result of repeated damage to the liver over time, resulting in scar tissue (fibrosis) within the liver. This fibrosis can prevent the liver from working normally.
There are many different causes of liver fibrosis, including autoimmune liver disease, metabolic liver disease, alcohol related liver disease, viral hepatitis, and inherited disorders.
Extensive liver fibrosis can result in cirrhosis. People with cirrhosis need regular careful monitoring to avoid complications. Complications include infections, clots in the veins supplying blood to the liver, liver cancer and swelling with excess fluid in the abdomen and on the legs.
Referrals
We welcome referrals from GPs and community services for patients with suspected advanced chronic liver disease of any cause. We support and welcome referrals from surrounding hospitals referring patients with complications of cirrhosis, including:
- diuretic resistant refractory ascites
- refractory encephalopathy
- portal/splanchnic vein thromboses
- hepatocellular carcinoma
- refractory or recurrent gastrointestinal bleeding secondary to portal hypertension
- recurrent hepatic hydrothorax
- hepatopulmonary syndrome
- hepatorenal syndrome
- ACLF — acute chronic liver failure
We provide access to a multitude of specialist services including:
- assessment for liver transplantation
- transjugular intrahepatic porto-systemic shunts (TIPS)
- tunnelled peritoneal catheter insertion
- liver intensive care
- advanced care planning
- alcohol liaison services
- dietetics and metabolic disease management
General practice
Please refer patients via the NHS e-Referral Service. Please enclose results of any recent imaging and a full liver screen.
Secondary care referrers
Outpatient assessment
Email your referral letter to rf-tr.
Urgent inpatient referrals
The liver unit has an on call hepatology specialist registrar/fellow supported by a consultant available to discuss referrals. Please contact the Royal Free Hospital switchboard on 020 7794 0500 and ask for the hepatology SpR.
Autoimmune and cholestatic liver diseases are a group of rare medical conditions that affect the liver and bile ducts. The major conditions in this group are:
- autoimmune hepatitis (AIH)
- primary biliary cholangitis (PBC)
- primary sclerosing cholangitis (PSC)
In addition to these three conditions, there are a range of other rarer conditions related to the immune system that affect the liver and bile ducts. They include:
- IgG-4 disease
- autoimmune sclerosing cholangitis
- immunodeficiency syndromes
All have their own treatment approaches.
Clinical care
We offer a full, multidisciplinary service for patients with consultant-led clinics and specialist nurse-led and pharmacist-led treatment clinics.
In addition, our clinical nurse specialists provide in-person and remote-access patient support and advice.
The clinics are supported by specialist multidisciplinary teams including histopathology, radiology, interventional radiology, hepatobiliary endoscopy (for ERCP and endoscopic ultrasound) and are closely linked to the Royal Free Hospital liver transplant service.
Regular, dedicated, specialist multidisciplinary meetings are held to review patients with complex AIH, PSC or PBC on a weekly or fortnightly basis, allowing us access to wide-ranging expert opinion.
We are an operational delivery network hub for the specialist provision of advanced and new treatments for PBC and link with national specialist networks including the national IgG-4 and primary immunodeficiency multidisciplinary meetings.
Referrals
Patients can be referred directly to the clinic by their GP for suspected or confirmed immune-mediated liver diseases, or by gastroenterologists and hepatologists from other UK hospitals.
We are happy to manage patients under joint care with their local hospital to minimise the inconvenience of travel to our centre if they live some distance away. We are also happy to review patients who are interested in clinical trials that are not available at their local centre.
Links
Research
There are three national patient research platforms with which we are actively involved. Their websites include information on research in autoimmune and cholestatic diseases.
They were all formed as collaborations between patient groups, doctors, scientists, and industry to improve understanding and treatment of AIH, PBC and PSC.
We offer a consultant-led clinic and a nurse-led venesection service for patients with haemochromatosis. For patients with Wilson’s disease, there is collaboration with neurologists and ophthalmologists to provide a multidisciplinary service.
The clinic is supported by specialist multi-disciplinary teams including histopathology, radiology and interventional radiology and is closely linked to the Royal Free Hospital liver transplant service.
What is Wilson’s disease?
Wilson’s disease is a rare genetic disorder that is fatal unless detected and treated before serious illness develops from copper poisoning. Wilson's disease affects about one in 30,000 people worldwide.
What is haemochromatosis?
Haemochromatosis is an inherited metabolic disorder causing the body to absorb an excessive amount of iron from the diet.
Research
In addition to specialist clinical care, we offer a portfolio of clinical trials and a range of research projects exploring the causes, management and outcomes of Wilson’s disease or haemochromatosis and its impact on patients’ lives. If they wish, patients may be eligible to take part in these studies to contribute to research, to donate samples (such as blood) to a research archive (biobank) and potentially to access novel treatments in clinical trials.
Links
The British Liver Trust is a UK-wide health charity that promotes liver health, campaigns to raise awareness about liver diseases and provides information and support for patients with liver diseases.
