Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 27, 2023; 15(4): 554-563
Published online Apr 27, 2023. doi: 10.4254/wjh.v15.i4.554
Inferior outcomes of liver transplantation for hepatocellular carcinoma during early-COVID-19 pandemic in the United States
Inkyu S Lee, Kenji Okumura, Ryosuke Misawa, Hiroshi Sogawa, Gregory Veillette, Devon John, Thomas Diflo, Seigo Nishida, Abhay Dhand
Inkyu S Lee, Kenji Okumura, Ryosuke Misawa, Hiroshi Sogawa, Gregory Veillette, Devon John, Thomas Diflo, Seigo Nishida, Abhay Dhand, Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
Abhay Dhand, Department of Medicine, Westchester Medical Center, Valhalla, NY 10595, United States
Author contributions: Lee IS and Okumura K contributed equally to this work; Lee IS, Okumura K, and Dhand A contributed to study design; Lee IS, Okumura K, Misawa R, Nishida S and Dhand A analyzed data and writing of the manuscript; Sogawa H, Veillette G, John D and Diflo T contributed to critical revision; all authors approved the final manuscript.
Institutional review board statement: All study methods were approved by New York Medical College Institutional Review Board.
Informed consent statement: Informed consent was waived for patients in the study because of the study's retrospective nature and the use of a retrospective database.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request. The data reported here have been supplied by the UNOS as the contractor for the OPTN. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the OPTN or the United States Government.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Kenji Okumura, MD, Doctor, Department of Surgery, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, United States.
Received: December 29, 2022
Peer-review started: December 29, 2022
First decision: January 30, 2023
Revised: March 5, 2023
Accepted: March 29, 2023
Article in press: March 29, 2023
Published online: April 27, 2023
Research background

Coronavirus disease 2019 (COVID-19) pandemic significantly impacted healthcare in the United States including transplantation and cancer care, especially early in the pandemic when there were challenges in access to routine healthcare.

Research motivation

To analyze the impact of COVID-19 pandemic on Liver transplantation (LT) for Hepatocellular carcinoma (HCC) in the United States.

Research objectives

All patient 18 years of age and older undergoing LT who were confirmed as HCC on pathology in the United States.

Research methods

Since WHO declared COVID-19 as a pandemic on March 11, 2020, we defined pre-COVID period as March 11 to September 11, 2019, and COVID period as March 11 to September 11, 2020.

Research results

Overall, 23.5% fewer LT for HCC were performed during the COVID period (518 vs 675, P < 0.05). Among pathological characteristics of HCC, vascular invasion was more prominent during COVID period (P < 0.01), while other features were the same. Among outcomes, 90-day overall and graft survival were the same, but 180-day overall and graft were significantly inferior during COVID period (94.7 vs 97.0%, P = 0.048). On multivariable Cox-hazard regression analysis, COVID period emerged as a significant risk factor of post-transplant mortality (Hazard ratio 1.85; 95%CI: 1.28-2.68, P = 0.001).

Research conclusions

During COVID period, there was a significant decrease in LTs performed for HCC. While early postoperative outcomes of LT for HCC were same, the overall and graft survival of LTs for HCC after 180 days were significantly inferior.

Research perspectives

To analyze the effects of COVID-19 pandemic in the long-term effects for LT for HCC.