Keeping the Lights On: Telehealth, Testing, and 6-Month Outcomes for Orthotopic Liver Transplantation During the COVID-19 Pandemic

Delman, Aaron M.; Turner, Kevin M.; Jones, Courtney R.; Vaysburg, Dennis M.; Silski, Latifa S.; King, Corey; Luckett, Keith; Safdar, Kamran; Quillin, Ralph C.; Shah, Shimul A.

INTRODUCTION: The COVID-19 pandemic has seen transplant volume decrease nationwide, resulting in a 2.2-fold increase in waitlist mortality. In particular, solid organ transplant patients are subjected to increased morbidity and mortality from infection. In the face of these challenges, transplant centers need to develop innovative protocols to ensure high-quality care. METHODS: A multidisciplinary protocol was developed that included: virtual selection meetings, COVID-19 negative donors, pre-transplant symptom screening, rapid testing on presentation, telehealth follow-up, and weekly community outreach town-halls. All OLTs completed between January 2018 and August 2020 were included in the study (n=344). The cohort was stratified from January 2018 – February 2020 as “pre-COVID-19,” and March 2020-August 2020 as “COVID-19.” Patient demographics and post-operative outcomes were compared. RESULTS: From March 2020 - August 2020 there was a significant decrease in average monthly referrals for liver transplantation (OLT) (29.8 vs. 37.1, p = 0.01). However, listings (11.0 vs. 14.3, p = 0.09) and transplant volume remained unchanged (12.2 vs. 10.6, p = 0.26). Rapid testing was utilized on arrival for transplant, zero patients tested positively preoperatively and median time from test result until abdominal incision was 4.5 hours [1.2, 9.2]. Simultaneously, telehealth visits increased rapidly, peaking at 85% of all visits. Importantly, there was no difference in outcomes between cohorts. CONCLUSION: OLT can be accomplished safely and effectively in the COVID-19 era without compromising outcomes through increasing utilization of telehealth, rapid COVID-19 testing, and multidisciplinary protocols for managing immunosuppressed patients.