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

Area of Science:

• Hepatology
• Transplant Surgery
• Public Health

Background:

• High-volume centers (HVCs) traditionally correlate with superior patient outcomes.
• The COVID-19 pandemic significantly reduced liver transplantation (LT) activity at our HVC.
• This study investigates the impact of decreased LT volume on post-transplant outcomes at an HVC.

Purpose of the Study:

• To assess the effect of reduced liver transplantation (LT) volume during the COVID-19 pandemic on patient outcomes.
• To compare the surgical outcomes of LT during the pandemic lockdown with the pre-pandemic period.
• To evaluate if outcomes at a high-volume center were non-inferior despite a decline in LT procedures.

Main Methods:

• A comparative study analyzing LT outcomes during the COVID-19 lockdown (April 2020-September 2020) versus the preceding year (April 2019-March 2020).
• Surgical outcomes were compared between the pandemic and pre-pandemic cohorts.
• Patient data included Model for End-Stage Liver Disease (MELD) scores, Child-Turcotte-Pugh scores, and mortality rates.

Main Results:

• LT volume was halved during the pandemic lockdown (60 patients) compared to the pre-pandemic year (228 patients).
• The pandemic cohort presented with significantly higher MELD and Child-Turcotte-Pugh scores, and a greater incidence of acute-on-chronic liver failure.
• Despite these challenges, 30-day, 3-month, and 6-month mortality rates were not statistically significantly different between the two groups.

Conclusions:

• A significant reduction in liver transplantation (LT) procedures occurred at our HVC during the COVID-19 pandemic.
• Outcomes for LT recipients during the pandemic were non-inferior to those in the pre-pandemic period, despite operating on sicker patients.
• Individualized patient care strategies likely contributed to maintaining non-inferior outcomes amidst pandemic-related challenges.