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

Ashley Jowell, BA, MS¹, Allison Kwong, MD, MS², Omar A. Alshuwaykh, MD³, Paul Kwo, MD^4
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.
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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.



Disclosures:


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.