Korean J Transplant.  2022 Jun;36(2):127-135. 10.4285/kjt.22.0017.

Living donor liver transplant outcomes during the COVID-19 pandemic: does a decrease in case volume impact the overall outcomes?

• Singh SA
• Pampaniya H
• Kumar V
• Kumar M
• Jadaun SS
• Yadav V
• Saigal S
• Gupta S

• KMID: 2531136
• DOI: http://doi.org/10.4285/kjt.22.0017

Abstract

Background
High-volume centers (HVCs) are classically associated with better out- comes. During the coronavirus disease 2019 (COVID-19) pandemic, there has been a decrease in the regular liver transplantation (LT) activity at our center. This study ana- lyzed the effect of the decline in LT on posttransplant patient outcomes at our HVC.
Methods
We compared the surgical outcomes of patients who underwent LT during the COVID-19 pandemic lockdown (April 1, 2020 to September 30, 2020) with outcomes in the pre-pandemic calendar year (April 1, 2019 to March 31, 2020).
Results
During the 6 months of pandemic lockdown, 60 patients underwent LT (43 adults and 17 children) while 228 patients underwent LT (178 adults and 50 children) during the pre-pandemic calendar year. Patients in the pandemic group had significant- ly higher model for end-stage liver disease (MELD) scores (24.39±9.55 vs. 21.14±9.17, P=0.034), Child-Turcotte-Pugh scores (11.46±2.32 vs. 10.25±2.24, P=0.03), and inci-dence of acute-on-chronic liver failure (30.2% vs. 10.2%, P=0.002). Despite performing LT in sicker patients with COVID-19-related challenges, the 30-day (14% vs. 18.5%, P=0.479), 3-month (16.3% vs. 20.2%, P=0.557), and 6-month mortality rates (23.3% vs. 28.7%, P=0.477) were lower, but not statistically significant when compared to the pre-pandemic cohort.
Conclusions
During the COVID-19 pandemic lockdown the number of LT procedures performed at our HVC declined by half because prevailing conditions allowed LT in very sick patients only. Despite these changes, outcomes were not inferior during the pan- demic period compared to the pre-pandemic calendar year. Greater individualization of patient care contributed to non-inferior outcomes in these sick recipients.

Keyword

Liver transplantation; SARS-CoV-2; Health care outcome assessment; Hospital bed capacity

Figure

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  Fig. 1 Bar graph depicting the number of liver transplantation procedures performed by month. LT, liver transplantation.

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  Fig. 2 Kaplan-Meier 1-year survival curves for pandemic and pre-pandemic groups. (A) Adult 1-year survival curve. (B) Pediatric 1-year survival curve. APG, adult pandemic group; AdP-PG, adult pre-pandemic group; PPG, pediatric pandemic group; PedP-PG, pediatric pre-pandemic group.

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