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. 2025 Jun 18;15(2):99401.
doi: 10.5500/wjt.v15.i2.99401.

Changes in the liver transplant evaluation process during the early COVID-19 era and the role of telehealth

Ashley H Jowell  1 , Allison J Kwong  2 , Reshma Reguram  3 , Tami J Daugherty  2 , Paul Yien Kwo  4
Affiliations

Changes in the liver transplant evaluation process during the early COVID-19 era and the role of telehealth

Ashley H Jowell et al. World J Transplant. .

Abstract

Background: Coronavirus disease 2019 (COVID-19) disrupted healthcare and led to increased telehealth use. We explored the impact of COVID-19 on liver transplant evaluation (LTE).

Aim: To understand the impact of telehealth on LTE during COVID-19 and to identify disparities in outcomes disaggregated by sociodemographic factors.

Methods: This was a retrospective study of patients who initiated LTE at our center from 3/16/20-3/16/21 ("COVID-19 era") and the year prior (3/16/19-3/15/20, "pre-COVID-19 era"). We compared LTE duration times between eras and explored the effects of telehealth and inpatient evaluations on LTE duration, listing, and pre-transplant mortality.

Results: One hundred and seventy-eight patients were included in the pre-COVID-19 era cohort and one hundred and ninety-nine in the COVID-19 era cohort. Twenty-nine percent (58/199) of COVID-19 era initial LTE were telehealth, compared to 0% (0/178) pre-COVID-19. There were more inpatient evaluations during COVID-19 era (40% vs 28%, P < 0.01). Among outpatient encounters, telehealth use for initial LTE during COVID-19 era did not impact likelihood of listing, pre-transplant mortality, or time to LTE and listing. Median times to LTE and listing during COVID-19 were shorter than pre-COVID-19, driven by increased inpatient evaluations. Sociodemographic factors were not predictive of telehealth.

Conclusion: COVID-19 demonstrates a shift to telehealth and inpatient LTE. Telehealth does not impact LTE or listing duration, likelihood of listing, or mortality, suggesting telehealth may facilitate LTE without negative outcomes.

Keywords: COVID-19; Health access; Health equity; Liver transplant evaluation; Telehealth.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Impact of telehealth initiation during coronavirus disease 2019 on liver transplant evaluation type and length. A: Type of liver transplant evaluation; B: Median time to liver transplant evaluation and listing; C: Coronavirus disease 2019 era time to liver transplant evaluation and listing among outpatients.
See this image and copyright information in PMC

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