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

Table 1 Overall cohort demographics and outcomes of patients evaluated before and after coronavirus disease 2019, n (%)

	Pre-COVID era, n = 178	COVID era, n = 199	P value
Median age, years (p 25-p 75)	62 (55-67)	58 (47-65)	0.002
Sex (male)	112 (64.0)	129 (64.8)	0.85
Preferred language other than English	45 (25.3)	40 (20.1)	0.28
Race/ethnicity			0.89
White	90 (50.6)	93 (46.7)
Asian	13 (7.3)	17 (8.5)
Hispanic	66 (37.1)	79 (39.7)
Black	2 (1.1)	4 (2.0)
Other	7 (3.9)	6 (3.0)
Insurance			0.78
Private	63 (35.4)	75 (37.7)
Medicare	66 (37.1)	67 (33.7)
Medi-cal	49 (27.5)	57 (28.6)
Etiology of liver disease
Hepatitis C only	21 (11.8)	18 (9.0)
Hepatitis C + alcohol induced liver disease	15 (8.4)	11 (5.5)
Alcohol induced liver disease only	73 (41)	92 (46.2)
Hepatitis B	9 (5.1)	5 (2.5)
Primary sclerosing cholangitis	4 (2.2)	4 (2.0)
Primary biliary cholangitis	4 (2.2)	6 (3.0)
Autoimmune hepatitis	1 (0.6)	5 (2.5)
Non-alcoholic steatohepatitis	36 (20.2)	32 (16.1)
Alpha 1 anti-trypsin	1 (0.6)	1 (0.5)
Wilson’s disease	0 (0.0)	1 (0.5)
Hemochromatosis	14 (7.9)	24 (12.1)
Median MELD-Na at evaluation (p 25-p 75)
All patients	17 (9-23)	21 (13-29)	< 0.001
Outpatient only	13 (8-19)	16 (10-20)	0.02
Median distance to Stanford Hospital (p 25-p 75) miles	58.0 (17.1-114.3)	58.6 (15.8-131.8)	0.91
Alcohol etiology	88 (49.4)	103 (51.8)	0.73
HCC diagnosis	60 (33.7)	42 (21.1)	0.008
Hepatology liver transplant evaluation			< 0.001
Office visit	128 (71.9)	62 (31.2)
Telehealth	0 (0.0)	58 (29.1)
Inpatient	50 (28.1)	79 (39.7)
Median days from evaluation to initial committee review (p 25-p 75)
All patients	26 (11-60)	13 (6-48)	0.004
Outpatient only	38 (15-69)	32 (11-69)	0.48
COVID era median days from evaluation to initial committee review (p 25-p 75)
Office visit	N/A	29 (11-63)	0.5
Telehealth	N/A	37.5 (11.3-74.8)
Median days from evaluation to listing (p 25- p 75)
All patients	35 (18-81)	19 (7-69)	0.02
Outpatient only	41 (19-104)	45 (11-102)	0.54
COVID era median days from evaluation to listing (p 25-p 75)
Office visit	N/A	46 (11-102)	0.9
Telehealth	N/A	42 (12-92.5)
Listed	100 (56.2)	115 (57.8)	0.83
COVID era listed
Office visit	N/A	41 (66.1)
Telehealth	N/A	28 (48.3)	0.07
Pre transplant mortality
All patients	N/A	51 (25.6)	N/A
Outpatient only		25 (20.8)
COVID era pre transplant mortality			0.25
Office visit	N/A	16 (25.8)
Telehealth	N/A	9 (15.5)
Transplanted	N/A	59 (29.6)	N/A
COVID era transplanted
Office visit	N/A	13 (21.0)	0.8
Telehealth	N/A	14 (24.1)

COVID: Coronavirus disease; MELD-Na: Model for end-stage liver disease with sodium; HCC: Hepatocellular carcinoma; N/A: Not applicable.