ABSTRACT
Background and aim: Access to liver transplantation (LT) can beaffected by several barriers resulting in delayed referral and increased risk of mortality. Therefore, hub-and-spoke networks have been implemented in order to manage patients with liver disease. COVID-19 pandemic may have significantly changed this scenario, as most of medical resources have been allocated for the care of patients with SARS-CoV-2 infection. This study aimed to assess the influence of COVID-19 pandemic on referrals of patients with liver disease to a LT Center.Materials and methods: An integrated referral program was developed since 10.2017 at Multivisceral Transplant Unit, PadovaUniversity. All consecutive adult patients with liver disease referred for the first time using this program from 10.2017 to 12.2020 were prospectively collected. Clinical characteristics were analyzedoverall and according to era of referral (pre-COVID-19 era:10.2017-02.2020;COVID-19 era:03.2020-12.2020).Results: 231 patients with liver disease were referred over the study period (men 61%, mean ± SD age: 54±10 years). End-stage liver disease was the most common underlying condition (78.3%), followed by acute liver injury/acute liver failure (17.3%). During COVID-19 pandemic, the rate of referred patients showed a stable trend, if compared with the previous period (5.1 patients/monthvs. 6.1 patients/month), also when only in-patient referrals wereconsidered (pre-COVID-19 era vs.COVID-19 era: 2.9 vs. 3.2 patients/month). Considering 181 patients with cirrhosis, underlying etiology (p=0.22), severity of liver disease (MELD score: 21±7 vs. 20±8;p=0.44), and inpatient referrals (42% vs. 51%;p=0.34) did not differ between pre-COVID-19 and COVID-19 eras. There was a decreasing rate of ICU admission for cirrhosis-related complicationsduring COVID-19 pandemic (22% vs. 34%;p=0.3), with an increased in-hospital transplant-free mortality (41% vs. 30%;p=0.3).Conclusions: Conclusion: Our results did not show a significant decrease in the number of referrals and type of indications during the COVID-19 pandemic;however, the in-hospital transplant free mortality showed an increasing trend, which could be the consequence of a decreasing rate of ICU admissions. Taken together, thesefactors confirmed the importance of a referral network for the care of patients with liver disease, but also how the COVID-19 pandemic may influence the short-term outcome of patients with liver disease.
ABSTRACT
Although Italy has been on track for Hepatitis C Virus (HCV) elimination since 2019, it fell off track due to the decrease in the number of treated patients. HCV elimination in Italy will be possible if immediate action is taken. A health policy was implemented beginning in 2021, consisting of screening among key populations and birth cohorts (1969-1989), estimated to have a high prevalence of undiagnosed individuals. The active screening requires regional governance that manages the processes' complexity integrating a well-organized network between territory assistance and hospital to achieve an effective HCV care cascade. This document aims to support the regional decision-making process by defining paths for screening and linkage-to-care. Implementing active screening strategies beyond a risk-based approach is required as a General Practitioners' task. Simplified paths must be drawn for the key populations screening. The infrastructure built for COVID-19 vaccination could be used also for HCV screening. According to a multidisciplinary care delivery, screening should be supplemented with rapid linkage-to-care and treatment of newly diagnosed patients. The realization of the proactive screening during the first two years is vital because it will define the tracks for the whole HCV cost-effective screening of 1948-1988 birth cohorts in Italy.