Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 18, 2023; 13(4): 169-182
Published online Jun 18, 2023. doi: 10.5500/wjt.v13.i4.169
Delayed referral for liver transplant evaluation worsens outcomes in chronic liver disease patients requiring inpatient transplant evaluation
Katherine M Cooper, Alessandro Colletta, Nicholas J Hathaway, Diana Liu, Daniella Gonzalez, Arslan Talat, Curtis Barry, Anita Krishnarao, Savant Mehta, Babak Movahedi, Paulo N Martins, Deepika Devuni
Katherine M Cooper, Alessandro Colletta, Nicholas J Hathaway, Diana Liu, Daniella Gonzalez, Department of Medicine, UMass Chan Medical School, Worcester, MA 01605, United States
Arslan Talat, Curtis Barry, Anita Krishnarao, Savant Mehta, Deepika Devuni, Department of Medicine, Division of Gastroenterology, UMass Chan Medical School, Worcester, MA 01605, United States
Babak Movahedi, Paulo N Martins, Department of Surgery, Transplant Division, UMass Chan Medical School, Worcester, MA 01605, United States
Author contributions: Cooper KM, Colletta A, Hathaway NJ, and Devuni D contributed to analysis and interpretation of data; Cooper KM, Talat A, and Devuni D contributed to study concept and design; Cooper KM, Colletta A, Liu D, Gonzalez D, Barry C, Krishnarao A, Mehta S, Movahedi B, and Martins PN contributed to acquisition of data; Cooper KM and Colletta A contributed to drafting of the manuscript; Cooper KM, Martins PN, and Devuni D contributed to critical revision of the manuscript for important intellectual content; Cooper KM and Hathaway NJ contributed to statistical analysis; Barry C, Krishnarao A, Mehta S, Movahedi B, and Martins PN contributed to material support; Devuni D contributed to study supervision.
Institutional review board statement: This study was reviewed and approved by the institutional review board at our medical center (IRB Docket: Study00000016, approved 10/24/21).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed care with informed consent. This study received a Health Insurance Portability and Accountability Act (HIPAA) waiver for informed consent at our institution through the IRB review process.
Conflict-of-interest statement: All authors have no conflicts of interest related to this study to report.
Data sharing statement: This study was reviewed and approved by the institutional review board at our medical center with a waiver of consent due to the retrospective nature of this study.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Katherine M Cooper, MD, Doctor, Department of Medicine, UMass Chan Medical School, 55 Lave Ave North, Worcester, MA 01605, United States. katherine.cooper@umassmed.edu
Received: April 25, 2023
Peer-review started: April 25, 2023
First decision: May 18, 2023
Revised: May 21, 2023
Accepted: June 6, 2023
Article in press: June 6, 2023
Published online: June 18, 2023
ARTICLE HIGHLIGHTS
Research background

Liver transplantation is the only definitive treatment for end stage liver disease, which has an increasing prevalence world wide. Despite this, there are many barriers to accessing liver transplant related care.

Research motivation

Barriers to timely liver transplant evaluation (LTE) are poorly understood and likely differ by geographic location.

Research objectives

We sought to perform a granular assessment of patients who completed inpatient LTE at our center and to identify risk factors for delayed LTE.

Research methods

We performed a single center retrospective cohort study analyzing patients with cirrhosis who completed LTE over 4 years. Patients were categorized as early or delayed LTE based on their clinical history. The electronic medical record was extensively reviewed to identify risk factors for delayed evaluation. Logistic regression was utilized to determine the effect of delayed evaluation on patient outcomes and to identify risk factors for delayed LTE.

Research results

Delayed referral increased the risk of death and decreased the odds of receiving a liver transplant. Female sex and trauma history to be predictors of delayed referral while malnutrition, work within the prior year, and prior smoking history were predictors of early referral. Documentation for 1 in 5 patients with delayed referral included misconceptions about candidacy and referenced inaccurate contraindications to transplant.

Research conclusions

Many patients undergo delayed LT which is associated with poor patient outcomes. Provider bias and patient psycho-social circumstances are both affect the timeliness of LTE and are targets for interventions aiming to improve access to liver transplantation.

Research perspectives

The use of granular data may improve the ability to identify patients at risk at individual centers.