Coronavirus Disease 2019 and Liver Transplantation: Lessons from the First Year of the Pandemic

Phipps, Meaghan; Verna, Elizabeth C.

doi:10.1002/lt.26194

Cited by 11 publications

(8 citation statements)

References 99 publications

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“…However, the continued changes in practice over time suggest the findings are not alone explained by COVID‐19. Although there was a brief decline in transplantations from March–June 2020 in the initial period of the COVID‐19 pandemic, transplantation numbers recovered and actually exceeded projections for the rest of the year, 14 thus contributing to the expected total number of transplantations of Era 3 shown in Table 1. Third, we made pre‐AC versus AC comparisons using current MELD allocation categories that were not used prior to the AC policy.…”

Section: Discussionmentioning

confidence: 99%

Center-level and region-level variations in liver transplantation practices following acuity circles policy change

Burton

Goldberg

2022

American Journal of Transplantation

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The Acuity Circles (AC) policy was implemented by the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) on February 4, 2020, with the goal of reducing variation in median Model for End-Stage Liver Disease (MELD) score at transplantation. A 2018 analysis by the Scientific Registry of Transplant Recipients (SRTR) predicted that AC would reduce variance in median MELD at transplant (MMAT) across donation service areas (DSAs), therefore reducing the geographical disparities present under Share 35. 1,2 However, the focus of analyses defining the 'success' of this policy has drawn on data at the national level (e.g., percentage of transplants within MELD categories or variance in MMAT), rather than changes in transplants at the local level (e.g., individual transplant centers).On a national level, the data suggest that the AC policy has been effective in achieving the goals of increasing access to transplant for patients with the highest MELD scores. 3 However, we reported in a 6-month preliminary study of AC that differences between individual centers and regions in the variance of MMAT may still be present

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Section: Discussionmentioning

confidence: 99%

Center-level and region-level variations in liver transplantation practices following acuity circles policy change

Burton

Goldberg

2022

American Journal of Transplantation

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“…However, we believe that 1 year of follow‐up provides sufficient evidence to demonstrate the disadvantages for HCC patients living in low MELD regions. Second, it is difficult to definitively know the effects of COVID‐19 on liver transplant evaluations, transplant listing, organ donation or organ procurement practices 15 . However, it is important to mention the two separate waves of COVID.…”

Section: Discussionmentioning

confidence: 99%

Changing opportunities for liver transplant for patients with hepatocellular carcinoma

Zendel

Watkins

Moon

et al. 2022

Clinical Transplantation

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Introduction Aim was to study the early impact of acuity circle‐based allocation implementation system on liver transplantation for hepatocellular carcinoma (HCC) patients. Methods We assessed characteristics of HCC and non‐HCC deceased donor orthotopic liver transplants (OLT) in the year before (2/2019–2/2020) and after (3/2020–2/2021) introduction of the acuity circle policy using the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) database. Results Total OLTs reduced from 6699 in the preacuity circle era to 6660 in the postacuity circle era (−.6%); this decrease is mostly driven by a decrease in HCC transplants (1529 to 1351; −11.6%). Six out of 11 regions had a reduction in the absolute number and percentage of HCC transplants with significant reductions in regions 2 (−37.8%, p < .001) and 4 (−28.3%, p = .001). Discussion The introduction of median model for end‐stage liver disease (MELD) at transplant minus 3 (MMaT‐3) exception points, has created differential opportunities for HCC patients, in low‐MELD as opposed to high‐MELD areas, despite having the same disease. This effect has become more prominent following the implementation of acuity circle‐based allocation system. Ongoing investigation of these trends is needed to ensure that HCC patients are not disparately disadvantaged due to their location.

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“…In other disciplines, this has been well documented. For example, in the setting of renal and liver transplantation, decreases in organ procurement, increases to post-transplant and waitlist mortality have been described throughout the period of the pandemic ( 19 , 20 ). The impact on the care of IBD patients has been largely limited to patient surveys that have subjectively documented the experience of IBD patients through the COVID-19 pandemic but the effect on objectives measures has been less well described ( 21 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

Increased Hospitalization for IBD Patients Seen in the ER During the COVID-19 Pandemic

Malhi

Minhas

Chambers

et al. 2022

Journal of the Canadian Association of Gastroenterology

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Background During the COVID-19 pandemic, the focus of many health care systems shifted in order to prioritize and allocate resources toward treating those affected by COVID-19. What this has meant for other patient populations remains unclear. We aimed to determine if there have been changes to acute care access for patients with inflammatory bowel disease (IBD) during the COVID-19 pandemic. Methods A retrospective cohort study was performed in IBD patients seen during (March 1, 2020 to August 31, 2020) and before (March 1, 2019 to August 31, 2019) the COVID-19 pandemic. IBD-related emergency room (ER) access, hospitalization, inpatient care and follow-up and post-discharge ER access were assessed. Results A total of 1229 participants were included. A higher proportion of patients accessed ER during the pandemic (44.6% versus 37.2%, P = 0.0097). A higher proportion of hospitalizations resulted from IBD-related ER visits during the pandemic period (41.6% versus 32.4%, OR = 1.48, 95% CI = 1.14 to 1.94, P = 0.0047), though length of stay was shorter (7.13 ± 8.95 days versus 10.11 ± 17.19 days, P = 0.015) and use of rescue infliximab was less. No change was seen in inpatient surgical intervention. Despite similar proportions of follow-up appointments post-hospital discharge (pre-pandemic, 77.9% versus pandemic, 78.3%), more ER visits occurred in the first 30 days following hospitalization for patients in the pandemic cohort (24.4% versus 11.1%, P = 0.0015). Conclusion These data highlight the need for ER services and hospitalization amongst IBD patients during the COVID-19 pandemic. This suggests that a return to pre-pandemic IBD care infrastructure is needed to mitigate the need for acute care access.

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Coronavirus Disease 2019 and Liver Transplantation: Lessons from the First Year of the Pandemic

Cited by 11 publications

References 99 publications

Center-level and region-level variations in liver transplantation practices following acuity circles policy change

Center-level and region-level variations in liver transplantation practices following acuity circles policy change

Changing opportunities for liver transplant for patients with hepatocellular carcinoma

Increased Hospitalization for IBD Patients Seen in the ER During the COVID-19 Pandemic

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