P085 Virtual transplant assessment is feasible and may increase access to liver transplantation

• Published in: Gut Vol. 70; no. Suppl 3; pp. A59 - A60
• Main Authors: Pradeep, Agimol, Barker, Faye, Ramos, Katie, Littlejohn, Wendy, Tavabie, Oliver, Nicholson, Chris, Menon, Krishna, Cramp, Matthew, McDougall, Neil, Cash, Johnny, Aluvihare, Varuna
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 17.09.2021; BMJ Publishing Group LTD
• Subjects: COVID-19; Liver diseases; Liver transplantation; Liver transplants; Pandemics; Patients; Smoking; Survival analysis; Transplants & implants
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2021-BASL.93

BackgroundIt has been demonstrated that patients living further from a transplant centre are less likely to be transplanted in the UK and abroad. King’s College Hospital (KCH) has collaborated with teams in Plymouth, North Bristol and Belfast to establish satellite transplant centres (SLTCs) to address this. However, the COVID-19 pandemic threatened to exacerbate this healthcare inequity by reducing travel and stopping patients undergoing transplant assessment at KCH. In response to this, we developed a virtual transplant assessment (VTA) pathway to ensure that patients at SLTCs were not disadvantaged through the pandemic.MethodsData were retrospectively collected from all patients referred from our SLTCs and discussed at KCH transplant listing meetings between April 2020 and April 2021. Patients were either assessed face-to-face or virtually depending on the ‘discussion in principle’ (DIP) MDM between KCH and the corresponding SLTC. Demographic (age and sex), clinical (disease aetiology, smoking history, time of referral, time of full discussion and whether the patient was listed for transplant or transplanted) and laboratory data for calculation of prognostic scores were collected from the clinical notes. Continuous variables were analysed for normality using the D’Agostino and Pearson test and patients undergoing face-to-face assessments were directly compared with those undergoing VTA by t test if normally distributed or Mann-Whitney U test if non-normally distributed. Categorical data were analysed using Fisher’s exact test. Time from listing to transplantation was compared between both groups by survival analysis.ResultsDuring this time, 19 patients underwent VTA and 30 patients underwent face-to-face assessment. No patients were fully assessed from SLTCs between April and July 2020. Initially, face-to-face assessments occurred more frequently as the VTA pathway was established. This reversed with VTA being more common than face-to-face assessments in 2021. There was a trend for patients undergoing VTA to be younger than those undergoing face-to-face assessment. No significant differences were observed when comparing sex, smoking status, disease aetiologies, prognostic scores and listing status. The VTA pathway was associated with a significantly longer time from DIP to full discussion: – this likely reflects that patients were assessed who had been waiting from the pre-pandemic era via VTA and initial obstacles encountered as part of a new program. No difference was observed in time from listing to transplantation (table 1) – however, long-term outcomes are currently limited.Abstract P085 Table 1Table demonstrating a comparison of demographic, clinical and prognostic scores between patients assessed via VTA and FTFA. Results from t tests are displayed as mean (SD). Results from Mann Whitney U tests are displayed as median (IQR). Results from Fisher’s exact tests are presented as number (%). Statistical significance was determined by a p value <0.05 and signified by *Variable N VTA (n=19) N FTFA (n=30) P value Age 19 57.0 (49.0–60.0) 30 61.5 (56.8–64.3) 0.05 Sex (male) 19 13 (68.4%) 30 18 (60.0%) 0.76 Current/Ex-smoker 19 8 (42.1%) 29 14 (48.3%) 0.77 ARLD 19 9 (47.4%) 30 9 (30.0%) 0.24 NAFLD 19 2 (10.5%) 30 5 (16.7%) 0.69 Autoimmune liver diseases (PBC/PSC/AIH) 19 6 (31.6%) 30 13 (43.3%) 0.55 Redo transplantation 19 1 (5.3%) 30 0 (0.0%) 0.39 HCC 19 0 (0.0%) 30 2 (6.7%) 0.52 UKELD 19 54.5 (5.7) 30 54.1 (6.0) 0.81 MELD 19 12 (10.3–16.8) 30 10 (6.8–13.5) 0.10 CP score 19 8.6 (2.7) 30 7.8 (1.6) 0.24 Time from referral to completion of assessment 19 62 (48.0–125.0) 28 42 (21.0–54.5) 0.01* Patient listed for transplant 19 18 (94.7%) 30 26 (86.7%) 0.64 ConclusionVTA is feasible and will increase access to transplantation. Long-term post-transplant outcome data is required to fully assess the pathway.