Hepatology, HPB, 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. 

North Middlesex University Hospital also offers a broad outpatient service with hepatology clinics.

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 managing 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

We 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

View contact information for this service.

Hepato-Pancreato-Biliary (HPB)

Clinical nurse specialists (cancer patients)

Clinical nurse specialists (non cancer patients)

HPB waiting list co-ordinators

Administration

RUQP administration

Hepatology

North Middlesex University Hospital

Royal Free Hospital

Endoscopy

North Middlesex University Hospital

Royal Free Hospital

Administration

If you need to contact a consultant or their team, email us and your enquiry will be forwarded to the appropriate person. Please include the patient’s name and date of birth and, if you know it, their NHS number or hospital number and the name of the doctor or specialist nurse you are trying to contact.

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.

The Royal Free hepatology team conducts community liver health check clinics across north central London and Hertfordshire as part of a national cancer programme. The aim is to improve the rates of early detection and diagnosis of liver cancer for the ability to offer treatment at an early stage. 

We target our clinic locations to offer the service to people who are most at risk of liver disease. This includes people with type 2 diabetes, obesity, viral hepatitis, and alcohol excess. Our mobile clinic helps us to make the clinic as accessible as possible. 

During the clinic appointment  we offer:

  1. Quick and painless liver scan to check for liver damage
  2. Instant results
  3. Discuss a plan for any next steps that are needed

Approximately 6,100 people are diagnosed with liver cancer each year. The incidence of liver cancer has increased by more than half over the past decade and is expected to rise. Current evidence suggests only a third of liver cancers are diagnosed at an early stage where curative treatment can be offered.

Video

Watch a video on how liver trucks' can catch cancer earlier in high-risk communities.

Clinic consultant

Prof Emmanouil Tsochatzis.

External resources and leaflets

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.hepatologyadmin@nhs.net.

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

Referrals

Early detection liver pathway referral form (word doc)

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  

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.  

The Royal Free Hospital is one of a very few specialist hospitals for patients with liver failure or in need of a liver transplant. Patients are transferred to our liver critical care unit (LCCU) from London and across the United Kingdom.

The liver unit was founded in 1959 and since then over 2500 people have received liver transplants and many thousands have received lifesaving care for liver disease.

Our patients are looked after by doctors, nurses and other team members with expertise in caring for very ill patients with liver disease.

Our team are experienced in caring for all types of liver diseases, but some common reasons patients are referred to LCCU are:

· acute liver failure

· complications of chronic liver disease (like cirrhosis)

· bleeding from the digestive tract

· need for a liver transplant

· pancreatitis

· need for complex liver, gall bladder or pancreas surgery

The intensive care teams have daily meetings with other teams such as liver medicine specialists (hepatologists), liver surgeons and infectious disease doctors to plan the best possible care for our patients.

We have a long history of developing new therapies for liver failure and working with colleagues at UCL and across the world we are able to offer our patients the most up to date treatments for liver disease.

Support information

British Liver Trust: for more information on liver disease and support for you and your loved one.

Contact information

If you are health professional working in the NHS you can visit our Sharepoint site for information on making a referral.

Between 8am and 6pm, please use the following numbers:

ICU 4th floor reception: 020 7794 0500 ext 24545, 24509 or 24510.

Outside of these hours, you can call the hospital switchboard number and ask to be put through to liver critical care unit: 020 7794 0500. This number can be used 24/7

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.hepatologyadmin@nhs.net.

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.  

The British Liver Trust

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.