Impact of COVID-19 on Liver Transplant Activity in the USA: Variation by Etiology and Cirrhosis Complications

Yong-Fang Kuo; Paul Kwo; Robert J Wong; Ashwani K Singal

doi:10.14218/JCTH.2022.00129

Impact of COVID-19 on Liver Transplant Activity in the USA: Variation by Etiology and Cirrhosis Complications

J Clin Transl Hepatol. 2023 Feb 28;11(1):130-135. doi: 10.14218/JCTH.2022.00129. Epub 2022 Aug 18.

Authors

Yong-Fang Kuo¹, Paul Kwo², Robert J Wong², Ashwani K Singal^{3

4}

Affiliations

¹ Department of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA.
² Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Healthcare System, Stanford University School of Medicine, Palo Alto, CA, USA.
³ University of South Dakota Sanford, School of Medicine, Vermillion, SD, USA.
⁴ Avera Transplant Institute, Sioux Falls, SD, USA.

Abstract

Background and aims: The COVID-19 pandemic has impacted the care of patients with liver disease. We examined impact of COVID-19 on liver transplant (LT) activity in the USA.

Methods: LT listings in the United Network for Organ Sharing (UNOS) database (April 2018-May 2021) were analyzed to examine the impact of COVID-19 pandemic on the LT activity based on etiology: hepatitis C virus (HCV), alcohol-associated liver disease (ALD), alcoholic hepatitis (AH), and nonalcoholic steatohepatitis (NASH) complications: hepatocellular carcinoma (HCC) and acute-on-chronic liver failure (ACLF) grade 2 or 3) and Model for End-Stage Liver Disease (MELD) score. Joinpoint regression models assessed time trend changes on a log scale.

Results: Of 23,871 recipients (8,995 in the COVID era, April 2018-February 2020), mean age 52 years, 62% men, 61% Caucasian, 32% ALD, 15% HCC, 30% ACLF grades 2-3, and mean MELD score 20.5), monthly LT changes were a decrease of 3.4% for overall LTs and 22% for HCC after September 2020, and increase of 4.5% for ALD since 11/2020 and 17% since 03/2021 for ACLF grade 2-3. Monthly MELD scores increased by 0.7 and 0.36 after June 2020 for HCV and HCC respectively.

Conclusions: The COVID-19 pandemic has impacted LT activity, with a decrease of LTs especially for HCC, and an increase of LTs for ALD and severe ACLF. Strategies are needed to reorganize cirrhosis patients to overcome the aftereffects of COVID-19 pandemic.

Keywords: COVID-19; OLT; Public policies; Region; UNOS.