title: Successful listing of patients for liver transplant was related to participation of referring doctor in the transplant program.
abstract: BACKGROUND
  Experience with liver transplantation is limited in many parts of Asia. Therefore, patients from nontransplant centers may not be referred in a timely fashion for transplants. Our aim was to evaluate the pattern of referral for liver transplantation and their outcomes in Singapore.
  
  
  METHODS
  Consecutive patients referred from 1990 to 2001 were reviewed. Patients from any hospital in Singapore (or the region) could be referred to the program. They were discussed at the weekly meetings. Appropriate patients were placed on the waiting list. "Pending" indicated that the disease was early or there were unsettled medical or social issues. Unsuitable patients were "rejected" for transplant.
  
  
  RESULTS
  There were 385 patients referred over a 12-year period. Hepatitis B cirrhosis and hepatocellular carcinoma (HCC) were the most common indications among adults, whereas biliary atresia was the most common for children. Pediatric patients were more likely than adult patients to be listed for transplant (53/76 vs 106/309, P < .001). Patients referred by regular attendees of the program were more likely to be accepted than nonattendees (38% vs 25%, P = .04). "Disease too early", "advanced HCC", and "refusal by family members" were the most common reasons for rejection.
  
  
  CONCLUSIONS
  Members of the Liver Transplant Program were more likely to refer suitable patients for transplant at the appropriate time. Better interaction between gastroenterologists inside and outside the transplant program would help to improve the timing of referrals for liver transplantation, and hence, patient survival.
authors.affiliation: Singapore Liver Transplant Program, National University Hospital, Singapore. waict@nuh.com.sg
authors.forename: C-T
authors.initials: CT
authors.lastname: Wai
authors.forename: K
authors.initials: K
authors.lastname: Prabhakaran
authors.forename: M
authors.initials: M
authors.lastname: Kaur
authors.forename: Y M
authors.initials: YM
authors.lastname: Lee
authors.forename: Y Y
authors.initials: YY
authors.lastname: Dan
authors.forename: D S
authors.initials: DS
authors.lastname: Sutedja
authors.forename: M M
authors.initials: MM
authors.lastname: Aw
authors.forename: S H
authors.initials: SH
authors.lastname: Quak
authors.forename: K
authors.initials: K
authors.lastname: Mak
authors.forename: J
authors.initials: J
authors.lastname: Isaac
authors.forename: K H
authors.initials: KH
authors.lastname: Lee
authors.forename: S G
authors.initials: SG
authors.lastname: Lim
mesh_terms: D000328:Adult; D002648:Child; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors / Q000600:supply & distribution*; D010820:Physicians; D012189:Retrospective Studies; D012846:Singapore; D014019:Tissue Donors / Q000523:psychology*; D016896:Treatment Outcome; D014850:Waiting Lists