Liver critical care unit

Healthcare professionals can refer directly to the liver critical care team.

Tel: 020 7794 0500, and ask for the liver critical care referral line.

Email: rf-tr.livercriticalcare@nhs.net

When you call the LCCU team

• You will speak directly to a LCCU clinician
• Please have all the information about your patient available including
  • Patient details, including NHS number
  • Recent medical history
  • Background medical condition and medication history
  • Blood and Imaging results

We will often ask you to join a Microsoft teams call to discuss the case with our multi-disciplinary team (liver critical care, hepatology, and HPB colleagues)

Before joining the teams call it would be helpful if you were logged into a computer where you can share imaging and blood results with our team.

Who should I refer to LCCU?

We can support patients with all causes of liver failure and if you have any concerns about your patient, we encourage a consultant-to-consultant discussion with our team.  

Types of liver failure:

Acute liver failure (ALF)

Acute Liver Failure is an emergency defined by a combination of encephalopathy and coagulopathy (INR more than 1.5) in a patient with no pre-existing liver disease.

ALF is subclassified into three main clinical types using the time from onset of liver injury to the time a patient develops hepatic encephalopathy, this is known as the jaundice to encephalopathy time.

The most common types in the UK are hyperacute (often from medication such as paracetamol) or sub-acute (which can be seronegative or from auto-immune or drug induced liver injury).

Acute-on-chronic liver failure (ALCF)

ACLF is decompensation and extra-hepatic organ failures in a patient with known advanced chronic liver disease / cirrhosis.  

This is often precipitated by an event such as sepsis, upper gastrointestinal bleeding or acute alcohol associated hepatitis.

People with ACLF can be considered for expedited liver transplant assessment and listing in the UK according to NHSBT criteria.  We encourage referral and discussion for all patients with ACLF.

Variceal bleeding

People with variceal bleeding often initially have an upper GI endoscopy locally, but if the bleeding cannot be controlled with standard treatments, they may need to come to RFL for specialist interventions such as:

• Advanced endoscopic therapies not available at local centres
• TIPS for refractory variceal bleeding (rescue TIPS)
• Pre-emptive TIPS for patient at considerable risk of re-bleeding (pTIPS)
• Percutaneous transhepatic or trans-splenic embolisation of bleeding varices

Severe alcohol associated hepatitis

Severe alcohol associated hepatitis (SAAH) is a syndrome of severe liver inflammation from alcohol characterised by:

• jaundice (usually with a bilirubin of more than 80 umol/L)
• coagulopathy
• hepatomegally
• features of an inflammatory response (often with an increased white cell count)

SAAH often results in organ failure prompting admission to critical care and is a common cause of ACLF.

Directions to the Liver Critical Care Unit for transfer teams:

The LCCU is in the south wing, on the fourth floor of the Royal Free Hospital.

Google map link: LCCU, Fourth Floor, Royal Free Hospital, Pond Street, London, NW3 2QG

Ambulances should park in the emergency department ambulance bay on the lower ground floor. Follow signs for the main hospital and use the main lifts (not the heart attack centre lift) to the fourth floor.