E0506 - Exploring the Impact of COVID-19 on Liver Transplant Evaluation

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Ashley Jowell, BA, MS

Stanford University School of Medicine
Palo Alto, CA

Ashley Jowell, BA, MS¹, Allison Kwong, MD, MS², Omar A. Alshuwaykh, MD³, Paul Kwo, MD⁴
¹Stanford University School of Medicine, Palo Alto, CA; ²Stanford University School of Medicine, Redwood CIty, CA; ³John Muir Health, Redwood City, CA; ⁴Stanford University University School of Medicine, Redwood City, CA

Introduction: The COVID-19 pandemic resulted in a disruption of healthcare delivery, including services for liver transplant evaluation (LTE) and an increase in alcohol consumption. Our aims were 1) explore the effect of telehealth services on LTE times with a focus on sociodemographic factors and 2) examine the changes in burden of alcohol associated liver disease (ALD) resulting in LTE during COVID-19.

Methods: Single-center retrospective review of patients who began LTE at our center from initiation of shelter-in-place 3/16/2020 to 10/1/2020 and during an identical time the year prior (3/16/2019 to 10/1/2019). Data collected included sociodemographic data, clinical data, encounter type (office, telehealth, inpatient) for LTE, and duration of evaluation.

Results: We noted shorter evaluation times in 106 subjects in 2020 compared to 82 subjects in 2019 (median 12 vs 33 days , p< 0.05) and higher MELD-Na scores in 2020 vs 2019 (median 21 vs 15, p< 0.05). Higher rates of inpatient LTE were noted in 2020 vs 2019 (42.5% vs 24.4%, p< 0.05). Telehealth rates in outpatient LTE were higher in 2020 vs 2019 (60.7% vs 0%, p< 0.05). No differences in time from outpatient LTE to committee review were noted in 2020 vs 2019 (median 32 vs 41 days, p=0.11). A quasi-Poisson multivariable linear regression analysis for time from LTE to committee review showed that Asian race (compared to white) and Medicare(compared to private insurance) were associated with longer time to committee review during COVID-19(p< 0.05) but not pre-COVID.
.

No differences in the proportion of patients with ALD undergoing LTE in 2020 vs 2019 for inpatient or all evaluations noted. ALD was not associated with a difference in median time to committee review or likelihood of liver transplant (LT) in 2020 or 2019.

Discussion: The COVID-19 period was associated with higher MELD-Na scores and a shorter LTE to committee review time which is explained by increased inpatient evaluations during this period. Under univariate analysis of outpatient encounters, there was no negative impact in time from LTE to committee review with the introduction of telehealth. However, multivariate analysis demonstrated that Asian race and Medicare use was associated with longer time from LTE to committee review during COVID-19, but the effect was not present pre-COVID. The prevalence of ALD remained stable during early COVID-19, and ALD did not impact LTE length or likelihood of LT. Future data is needed to define the impact of COVID-19 and telehealth practices on LTE.

Cohort Details

2019

2020

Significance

Median time to committee review all patient (IQR)

33 (11-66)

12 (5-42)

p=0.0026

Median time to committee review outpatient only (IQR)

41 (14-88)

32 (11-69)

Median MELD-Na at evaluation (IQR)

15 (8-23)

21 (11-29)

p=0.0025

Encounter Type
Office Visit
Telehealth
Inpatient

62 (75.6%)
0 (0.0%)
20 (24.4%)

24 (22.6%)
37 (34.9%)
45 (42.5%)

p=0.0131*

Race
Asian
Hispanic
White
Other

11 (13.4%)
29 (35.3%)
39 (47.6%)
3 (3.7%)

13 (12.3%)
48 (45.3%)
45 (42.5%)
0 (0.0%)

Insurance
Medi-Cal
Medicare
Other/ Government
Private

24 (29.3%)
31 (37.8%)
2 (2.4%)
25 (30.5%)

35 (33.0%)
34 (32.1%)
1 (0.9%)
36 (34.0%)

Language
English
Other

61 (74.4%)
21 (25.6%)

78 (73.6%)
28 (26.4%)

ALD
No ALD
ALD

36 (43.9%)
46 (56.1%)

54 (50.9%)
52 (49.1%)

Table: Liver Transplant Evaluation Data
* Pooled outpatient encounters vs inpatient encounters

Disclosures:

Ashley Jowell indicated no relevant financial relationships.

Allison Kwong indicated no relevant financial relationships.

Omar Alshuwaykh indicated no relevant financial relationships.

Paul Kwo: 89 Bio – Advisor or Review Panel Member. Abbvie – Advisory Committee/Board Member. Aligos – Advisor or Review Panel Member. Altimmune – Grant/Research Support. Ambyss – Advisor or Review Panel Member. Antios – Advisory Committee/Board Member. Arrowhead – Grant/Research Support. BMS – Grant/Research Support. Direct – Stock Options. Drug Farm – Advisor or Review Panel Member. Eiger – Grant/Research Support. Eisai – Advisor or Review Panel Member. Enact – Advisor or Review Panel Member. Gilead – Advisor or Review Panel Member, Grant/Research Support. Hepquant – Advisor or Review Panel Member. Inventiva – Advisor or Review Panel Member, Grant/Research Support. Janssen – Grant/Research Support. Lygenesis – Advisor or Review Panel Member. Mallinckrodt – Advisory Committee/Board Member. Novonordisk – Grant/Research Support. Surrozen – Advisor or Review Panel Member. Target registries – Grant/Research Support.

Ashley Jowell, BA, MS¹, Allison Kwong, MD, MS², Omar A. Alshuwaykh, MD³, Paul Kwo, MD⁴. E0506 - Exploring the Impact of COVID-19 on Liver Transplant Evaluation, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.