Changes in the liver transplant evaluation process during the early COVID-19 era and the role of telehealth

• DOI: 10.5500/wjt.v15.i2.99401
• Publication Date: 2025-02-21T00:40:41Z
• Authors: Ashley H Jowell; Allison J Kwong; Reshma Reguram; Tami J Daugherty; Paul Yien Kwo

BACKGROUND Coronavirus disease 2019 (COVID-19) disrupted healthcare and led to increased telehealth use. We explored the impact of COVID-19 on liver transplant evaluation (LTE). AIM To understand the impact of telehealth on LTE during COVID-19 and to identify disparities in outcomes disaggregated by sociodemographic factors. METHODS This was a retrospective study of patients who initiated LTE at our center from 3/16/20-3/16/21 (“COVID-19 era”) and the year prior (3/16/19-3/15/20, “pre-COVID-19 era”). We compared LTE duration times between eras and explored the effects of telehealth and inpatient evaluations on LTE duration, listing, and pre-transplant mortality. RESULTS One hundred and seventy-eight patients were included in the pre-COVID-19 era cohort and one hundred and ninety-nine in the COVID-19 era cohort. Twenty-nine percent (58/199) of COVID-19 era initial LTE were telehealth, compared to 0% (0/178) pre-COVID-19. There were more inpatient evaluations during COVID-19 era (40% vs 28%, P < 0.01). Among outpatient encounters, telehealth use for initial LTE during COVID-19 era did not impact likelihood of listing, pre-transplant mortality, or time to LTE and listing. Median times to LTE and listing during COVID-19 were shorter than pre-COVID-19, driven by increased inpatient evaluations. Sociodemographic factors were not predictive of telehealth. CONCLUSION COVID-19 demonstrates a shift to telehealth and inpatient LTE. Telehealth does not impact LTE or listing duration, likelihood of listing, or mortality, suggesting telehealth may facilitate LTE without negative outcomes.