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

doi:10.5500/wjt.v15.i2.99401

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Transplant. Jun 18, 2025; 15(2): 99401
Published online Jun 18, 2025. doi: 10.5500/wjt.v15.i2.99401

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

Paul Yien Kwo, Tami J Daugherty, Reshma Reguram, Allison J Kwong, Ashley H Jowell

Ashley H Jowell, Department of Medicine, Duke University Medical Center, Durham, NC 27710, United States

Allison J Kwong, Tami J Daugherty, Paul Yien Kwo, Department of Medicine, Stanford University, Redwood City, CA 94063, United States

Reshma Reguram, Department of Medicine, Trinity Health, Pontiac, MI 48341, United States

Author contributions: Jowell AH, Kwo PY, and Daugherty TJ designed the original research project; Jowell AH and Reguram R conducted the retrospective chart review; Kwong AJ provided statistical expertise and conducted the research analysis as well as helped write the methods; Jowell AH wrote the initial draft of the manuscript, with feedback and edits from all co-authors; Kwo PY served as the project’s principal investigator and provided iterative guidance and detailed feedback throughout all stages of the project.

Institutional review board statement: This study was approved by the Stanford University Institutional Review Board, Panel on Medical Human Subjects in accordance with both the Declarations of Helsinki and Istanbul (Institutional Review Board number 40095).

Informed consent statement: This study received a waiver of informed consent.

Conflict-of-interest statement: The authors declare no conflict of interest.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Data sharing statement: No additional data are available.

Corresponding author: Paul Yien Kwo, FAASLD, AGAF, FACG, MD, Professor, Department of Medicine, Stanford University, 430 Broadway, Pavilion C 3^rd Floor, Redwood City, CA 94063, United States. pkwo@stanford.edu

Received: July 22, 2024
Revised: November 25, 2024
Accepted: December 25, 2024
Published online: June 18, 2025
Processing time: 214 Days and 8.6 Hours

Abstract

BACKGROUND

Coronavirus disease 2019 (COVID-19) disrupted healthcare and led to increased telehealth use. We explored the impact of COVID-19 on liver transplant evaluation (LTE).

AIM

To understand the impact of telehealth on LTE during COVID-19 and to identify disparities in outcomes disaggregated by sociodemographic factors.

METHODS

This was a retrospective study of patients who initiated LTE at our center from 3/16/20-3/16/21 (“COVID-19 era”) and the year prior (3/16/19-3/15/20, “pre-COVID-19 era”). We compared LTE duration times between eras and explored the effects of telehealth and inpatient evaluations on LTE duration, listing, and pre-transplant mortality.

RESULTS

One hundred and seventy-eight patients were included in the pre-COVID-19 era cohort and one hundred and ninety-nine in the COVID-19 era cohort. Twenty-nine percent (58/199) of COVID-19 era initial LTE were telehealth, compared to 0% (0/178) pre-COVID-19. There were more inpatient evaluations during COVID-19 era (40% vs 28%, P < 0.01). Among outpatient encounters, telehealth use for initial LTE during COVID-19 era did not impact likelihood of listing, pre-transplant mortality, or time to LTE and listing. Median times to LTE and listing during COVID-19 were shorter than pre-COVID-19, driven by increased inpatient evaluations. Sociodemographic factors were not predictive of telehealth.

CONCLUSION

COVID-19 demonstrates a shift to telehealth and inpatient LTE. Telehealth does not impact LTE or listing duration, likelihood of listing, or mortality, suggesting telehealth may facilitate LTE without negative outcomes.

Keywords: Liver transplant evaluation; Telehealth; Health access; Health equity; COVID-19

Core Tip: The coronavirus disease 2019 pandemic led to a shift to telehealth for liver transplant (LT) evaluations (LTEs). In this study, the authors found that telehealth did not have an impact on likelihood of listing, waitlist mortality, or evaluation length for patients undergoing LTE. These findings suggest that telehealth is a safe alternative for LTEs, and that outcomes are no different to in-person evaluations. These findings have important implications: Telehealth can help improve access to LT services, especially as telehealth can be of increased convenience to patients.