Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jul;18(8):1822-1830.e4.
doi: 10.1016/j.cgh.2019.12.021. Epub 2019 Dec 27.

Use of Telehealth Expedites Evaluation and Listing of Patients Referred for Liver Transplantation

Binu V John  1 , Eleanor Love  2 , Bassam Dahman  3 , Nargiza Kurbanova  4 , Venkata Rajesh Konjeti  4 , Latha Thankam Sundaram  5 , Yangyang Deng  3 , Sean Aubuchon  2 , Douglas Heuman  5 , Jasmohan S Bajaj  6 , Hochong Gilles  5 , Michael Chang  7 , Rehan Qayyum  4 , Mohammad S Siddiqui  8
Affiliations

Use of Telehealth Expedites Evaluation and Listing of Patients Referred for Liver Transplantation

Binu V John et al. Clin Gastroenterol Hepatol. 2020 Jul.

Abstract

Background & aims: Liver transplantation is the only treatment that increases survival times of patients with decompensated cirrhosis. Patients who live farther away from a transplant center are disadvantaged. Health care delivery via telehealth is an effective way to manage patients with decompensated cirrhosis remotely. We investigated the effects of telehealth on the liver transplant evaluation process.

Methods: We performed a retrospective study of 465 patients who underwent evaluation for liver transplantation at the Richmond Veterans Affairs Medical Center from 2005 through 2017. Of these, 232 patients were evaluated via telehealth, and 233 via in-person evaluation. Using regression models, we evaluated the differential effects of telehealth vs usual care on placement on the liver transplant waitlist. We also investigated the effects of telehealth on time from referral to initial evaluation by a transplant hepatologist, liver transplantation, and mortality.

Results: Patients in the telehealth group were evaluated significantly faster than patients evaluated in person, without or with adjustment for potential confounders (21.7 vs 79.5 d; P < .01). Telehealth also was associated with a significantly shorter time on the liver transplant waitlist (138.8 vs 249 d; P < .01). After propensity-matched analysis, telehealth was associated with a reduction in the time from referral to evaluation (hazard ratio, 0.15; 95% CI, 0.09-0.21; P < .01) and listing (hazard ratio, 0.26; 95% CI, 0.12-0.40; P < .01), but not to transplantation. In the intent-to-treat analysis of all referred patients, we found no significant difference in pretransplant mortality between patients evaluated via telehealth vs in-person. There was statistically significant interaction between model for end-stage liver disease (MELD)-Na scores and time to evaluation (P = .009) and placement on the transplant waitlist (P = .002), with telehealth offering greater benefits to patients with low MELD-Na scores.

Conclusions: Use of telehealth is associated with a substantial reduction in time from referral to initial evaluation by a hepatologist and placement on the liver transplant waitlist, especially for patients with low MELD scores, with no changes in time to transplantation or pretransplant mortality. More studies are needed, particularly outside of the Veterans Administration Health System, to confirm that telehealth is a safe and effective way to expand access for patients undergoing evaluation for liver transplantation.

Keywords: Health Care Disparities; Specialty Care Access; Tele-medicine; Waitlist Time.

PubMed Disclaimer

Conflict of interest statement

COI: BVJ serves on medical advisory boards for Gilead and Eisai and receives institutional research funding from Eisai, Bristol Myers Squibb, Bayer, Exact Sciences and Varian. Other authors disclose no conflicts.

Figures

Figure 1:
Figure 1:
Flow of patients referred for liver transplantation (n=715)
Figure 2:
Figure 2:
Time from referral to evaluation (panel A), listing (panel B) and transplantation (panel C) in patients evaluated by Telehealth versus in-person, by MELD-Na
Figure 3:
Figure 3:
Kaplan-Meier survival curve between those evaluated by Telehealth versus in-person evaluation (usual care)
See this image and copyright information in PMC

Comment in

References

    1. Martin P, DiMartini A, Feng S, et al. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology. 2014;59(3):1144. - PubMed
    1. Merion R, Schaubel DE, Dykstra DM, et al. The survival benefit of liver transplantation. Am J Transplant. 2005. February;5(2):307–13. - PubMed
    1. Hart A, Schladt DP, Zeglin J, et al. Predicting Outcomes on the Liver Transplant Waiting List in the United States: Accounting for Large Regional Variation in Organ Availability and Priority Allocation Points. Transplantation. 2016;100(10):2153–9. - PMC - PubMed
    1. Goldberg DS, French B, Forde KA, et al. Association of distance from a transplant center with access to waitlist placement, receipt of liver transplantation, and survival among US veterans. JAMA. 2014;311(12):1234–43. - PMC - PubMed
    1. Ross K, Patzer RE, Goldberg DS et al. Sociodemographic Determinants of Waitlist and Posttransplant Survival Among End-Stage Liver Disease Patients. Am J Transplant; 2017; 17: 2879–2889 - PubMed

Publication types