The positive impact of the COVID- 19 Pandemic on Organ Utilisation in Liver Transplantation

Background As the world recovers from the aftermath of devastating waves of an outbreak, the ongoing Coronavirus disease 2019 pandemic has presented a unique perspective to the transplantation community of ‘'organ utilisation'' in liver transplantation, a poorly defined term and ongoing hurdle in this field. To this end, we report the key metrics of transplantation activity from a high-volume liver transplantation centre in the United Kingdom over the past two years. Methods Between March 2019 and February 2021, details of donor liver offers received by our centre from National Health Service Blood & Transplant, and of transplantation were reviewed. Differences in the activity before and after the outbreak of the pandemic, including short term post-transplant survival, have been reported. Results The pandemic year at our centre witnessed a higher utilisation of Donation after Cardiac Death livers (80.4% vs. 58.3%, p=0.016) with preserved United Kingdom donor liver indices and median donor age (2.12 vs. 2.02, p=0.638;55 vs. 57 years, p=0.541) when compared to the pre-pandemic year. The 1- year patient survival rates for recipients in both the periods were comparable. The pandemic year, that was associated with increased utilisation of Donation after Cardiac Death livers, had an ischemic cholangiopathy rate of 6%. Conclusions The pressures imposed by the pandemic led to increased utilisation of specific donor livers to meet patient needs and minimise the risk of death on the waiting list, with apparently preserved early post-transplant survival. Optimum organ utilisation is a balancing act between risk and benefit for the potential recipient, and technologies like machine perfusion may allow surgeons to increase utilisation without compromising patient outcomes.

Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin for post-operative sepsis/infection in liver transplantation.

BACKGROUND: Post-operative infection is a major cause of morbidity and mortality in Liver Transplantation (LT). Early diagnosis and antimicrobial treatment improves outcomes and ruling out sepsis aids immunosuppression decisions. Procalcitonin (PCT) has recently become part of such decision making in COVID-19 pneumonia but its role in LT is not established. We assessed the diagnostic accuracy of PCT as a diagnostic biomarker for infection or sepsis following LT. METHODS: A systematic search was conducted for studies reporting diagnostic performance of PCT for infection/sepsis following LT. Studies were assessed for reporting of diagnostic accuracy, relevance and quality. RESULTS: Eight studies with 363 participants reported data on the diagnostic accuracy of PCT, with pooled sensitivity, specificity, diagnostic odds ratio and summary receiver operator curve of 70% (95% CI 62-78), 77% (95% CI 73-83), 15.82 (95% CI 5.82-43.12) and 0.871 respectively. There was variability in the timing of sampling (post-operative day 1-8) and range of cut-off values (0.48 to 42.8 ng/mL). Heterogeneity was reduced when only studies with adult LT recipients were considered. CONCLUSIONS: PCT performs moderately well as a diagnostic test for postoperative infection/sepsis following LT. This marker is more suited for use in adult LT populations.

Celebrate early and often: departing IFJP 2018–2021 editorial team thank you

An editorial is presented about the challenges that the world is facing in the face of Covid-19 Pandemic which brought diseases, economic recession, and long-term uncertainty. It discusses marginalized groups and those marginalized within groups bearing more of the consequences of these upheavals and feminists raising awareness of the ways in which caste, gender, race, disability, sexuality, and colonial and neocolonial oppressions have been exacerbated.

Impact of SARS-CoV-2 pandemic on pancreatic cancer services and treatment pathways: United Kingdom experience.

INTRODUCTION: The SARS-CoV-2 pandemic presented healthcare providers with an extreme challenge to provide cancer services. The impact upon the diagnostic and treatment capacity to treat pancreatic cancer is unclear. This study aimed to identify national variation in treatment pathways during the pandemic. METHODS: A survey was distributed to all United Kingdom pancreatic specialist centres, to assess diagnostic, therapeutic and interventional services availability, and alterations in treatment pathways. A repeating methodology enabled assessment over time as the pandemic evolved. RESULTS: Responses were received from all 29 centres. Over the first six weeks of the pandemic, less than a quarter of centres had normal availability of diagnostic pathways and a fifth of centres had no capacity whatsoever to undertake surgery. As the pandemic progressed services have gradually improved though most centres remain constrained to some degree. One third of centres changed their standard resectable pathway from surgery-first to neoadjuvant chemotherapy. Elderly patients, and those with COPD were less likely to be offered treatment during the pandemic. CONCLUSION: The COVID-19 pandemic has affected the capacity of the NHS to provide diagnostic and staging investigations for pancreatic cancer. The impact of revised treatment pathways has yet to be realised.

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

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.

Trinational Study Exploring the Early Impact of the COVID-19 Pandemic on Organ Donation and Liver Transplantation at National and Unit Levels.

BACKGROUND: The coronavirus disease (COVID-19) pandemic is stressing healthcare services to an unprecedented extent. There is anecdotal evidence of reduction in organ donation and transplantation activity across the world. METHODS: The weekly organ donation and liver transplant numbers over a 3-month period (Feb 17, 2020, till May 17, 2020) for the United States, United Kingdom, and India were compared with their previous year's activity. Liver transplant activity in 6 centers from these countries with varying local COVID-19 caseload was also compared. RESULTS: The COVID-19 pandemic has led to a significant contraction in organ donation and liver transplantation in all 3 countries. Peak reduction ranged from 25% in the United States to over 80% in the United Kingdom and India. The reduction was different for deceased donor and living donor liver transplantation and varied between centers within a country. There was early evidence of recovery of deceased donation in the United States and United Kingdom and resumption of living donor liver transplantation activity in India toward the end of the study period. A number of policy changes were undertaken at national and transplant center levels to ensure safe transplantation despite significant redirection of resources to combat the pandemic. CONCLUSIONS: There was a substantial reduction in organ donation and liver transplantation activity across the 3 countries with signs of recovery toward the end of the study period. Multiple factors including COVID-19 severity, stress on resources and influence of regulatory agencies and local factors are responsible for the reduction and recovery.