LIVER TRANSPLANTATION EVALUATION BY TELEMEDICINE IS ASSOCIATED WITH EXPEDITED EVALUATION AND LISTING

ABSTRACT

Background and Aims: The recent COVID-19 pandemic has upended health care delivery in the United States and the world, resulting in a rapid switch from in-person patient interactions to telemedicine. While telemedicine evaluation offers many advantages including convenience, patient satisfaction and improved access, it is unclear if it is an adequate substitute for in-person evaluation for complex interventions such as liver transplantation. There is a dearth of multi-center data on transplant evaluation using telemedicine and its impact on liver transplant outcomes. Methods: We performed a retrospective analysis of 1,118 non-local patients who underwent non-urgent evaluation for liver transplantation within the Veterans Affairs Health care system, which had implemented liver transplant evaluation by telemedicine predating COVID-19. During the study period, 176 patients underwent initial evaluation by telemedicine and 942, by an in-person evaluation. We studied the association of evaluation by telemedicine on pre-transplant mortality, as well as with time to evaluation, listing and transplantation. Results: After its initial introduction, the proportion of patients who underwent transplant evaluation by telemedicine, increased from 1.6% in 2013 to 20.2% in 2017. The percentage of telemedicine adoption varied across centers, from 0.5% to 44.2% of all evaluations. Patients in the telemedicine group had a shorter unadjusted time from referral to evaluation (20.0 vs. 27.0 days, p<0.0001), and listing (65.0 vs. 99.0 days, p<0.0001). There were no differences in time from referral to transplantation (220.5 vs. 265.5 days, p=0.25). These differences were maintained on an adjusted analysis, with transplant evaluation by telemedicine associated with a shorter adjusted time from referral to evaluation (19.4 vs. 28.9 days, p<0.001), and listing (97.4 vs. 118.7 days, p=0.0003), but not to transplantation (253.3 vs. 311.2 days, p=0.06). Telemedicine offered the highest benefit in patients with MELD below 20. Conclusion: In a national multi-center study within the VA system, Liver transplant evaluation by telemedicine is associated with a shorter time to evaluation and listing, and a trend towards shorter time to transplantation. (Table presented.) Time from referral to evaluation, listing and transplantation, by telemedicne or in-person evaluation (Generalized linear regression) by MELD-Na