Impact of COVID-19 on Liver Transplantation in Hong Kong and Singapore: A Modelling Study

Background: Liver transplantation (LT) activities during the COVID-19 pandemic have been curtailed in many countries. The impact of various policies restricting LT on outcomes of potential LT candidates is unclear. Methods: We studied all patients on the nationwide LT waitlists in Hong Kong and Sing...

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Autores principales:	Eunice Xiang-Xuan Tan, Wei Liang Quek, Suryadi, Haroun Chahed, Shridhar Ganpathi Iyer, Prema Raj Jeyaraj, Guan-Huei Lee, Albert Chan, Stephanie Cheng, Jan Hoe, Ek Khoon Tan, Lock Yue Chew, James Fung, Melvin Chen, Mark D. Muthiah, Daniel Q. Huang
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Liver transplant COVID-19 outcomes survival modelling hepatocellular carcinoma Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/a27013ff1c79401ca6a3abf485f3a9a1
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spelling	oai:doaj.org-article:a27013ff1c79401ca6a3abf485f3a9a12021-12-02T05:04:02ZImpact of COVID-19 on Liver Transplantation in Hong Kong and Singapore: A Modelling Study2666-606510.1016/j.lanwpc.2021.100262https://doaj.org/article/a27013ff1c79401ca6a3abf485f3a9a12021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666606521001711https://doaj.org/toc/2666-6065Background: Liver transplantation (LT) activities during the COVID-19 pandemic have been curtailed in many countries. The impact of various policies restricting LT on outcomes of potential LT candidates is unclear. Methods: We studied all patients on the nationwide LT waitlists in Hong Kong and Singapore between January 2016 and May 2020. We used continuous time Markov chains to model the effects of different scenarios and varying durations of disruption on LT candidates. Findings: With complete cessation of LT, the projected 1-year overall survival (OS) decreased by 3•6%, 10•51% and 19•21% for a 1-, 3- and 6-month disruption respectively versus no limitation to LT, while 2-year OS decreased by 4•1%, 12•55%, and 23•43% respectively. When only urgent (acute-on-chronic liver failure [ACLF] or acute liver failure) LT was allowed, the projected 1-year OS decreased by a similar proportion: 3•1%, 8•41% and 15•20% respectively. When deceased donor LT (DDLT) and urgent living donor LT (LDLT) were allowed, 1-year projected OS decreased by 1•2%, 5•1% and 8•85% for a 1-, 3- and 6-month disruption respectively. OS was similar when only DDLT was allowed. Complete cessation of LT activities for 3-months resulted in an increased projected incidence of ACLF and hepatocellular carcinoma (HCC) dropout at 1-year by 49•1% and 107•96% respectively. When only urgent LT was allowed, HCC dropout and ACLF incidence were comparable to the rates seen in the scenario of complete LT cessation. Interpretation: A short and wide-ranging disruption to LT results in better outcomes compared with a longer duration of partial restrictions. Funding: None to disclose.Eunice Xiang-Xuan TanWei Liang Quek SuryadiHaroun ChahedShridhar Ganpathi IyerPrema Raj JeyarajGuan-Huei LeeAlbert ChanStephanie ChengJan HoeEk Khoon TanLock Yue ChewJames FungMelvin ChenMark D. MuthiahDaniel Q. HuangElsevierarticleLiver transplantCOVID-19outcomessurvivalmodellinghepatocellular carcinomaPublic aspects of medicineRA1-1270ENThe Lancet Regional Health. Western Pacific, Vol 16, Iss , Pp 100262- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Liver transplant COVID-19 outcomes survival modelling hepatocellular carcinoma Public aspects of medicine RA1-1270
spellingShingle	Liver transplant COVID-19 outcomes survival modelling hepatocellular carcinoma Public aspects of medicine RA1-1270 Eunice Xiang-Xuan Tan Wei Liang Quek Suryadi Haroun Chahed Shridhar Ganpathi Iyer Prema Raj Jeyaraj Guan-Huei Lee Albert Chan Stephanie Cheng Jan Hoe Ek Khoon Tan Lock Yue Chew James Fung Melvin Chen Mark D. Muthiah Daniel Q. Huang Impact of COVID-19 on Liver Transplantation in Hong Kong and Singapore: A Modelling Study
description	Background: Liver transplantation (LT) activities during the COVID-19 pandemic have been curtailed in many countries. The impact of various policies restricting LT on outcomes of potential LT candidates is unclear. Methods: We studied all patients on the nationwide LT waitlists in Hong Kong and Singapore between January 2016 and May 2020. We used continuous time Markov chains to model the effects of different scenarios and varying durations of disruption on LT candidates. Findings: With complete cessation of LT, the projected 1-year overall survival (OS) decreased by 3•6%, 10•51% and 19•21% for a 1-, 3- and 6-month disruption respectively versus no limitation to LT, while 2-year OS decreased by 4•1%, 12•55%, and 23•43% respectively. When only urgent (acute-on-chronic liver failure [ACLF] or acute liver failure) LT was allowed, the projected 1-year OS decreased by a similar proportion: 3•1%, 8•41% and 15•20% respectively. When deceased donor LT (DDLT) and urgent living donor LT (LDLT) were allowed, 1-year projected OS decreased by 1•2%, 5•1% and 8•85% for a 1-, 3- and 6-month disruption respectively. OS was similar when only DDLT was allowed. Complete cessation of LT activities for 3-months resulted in an increased projected incidence of ACLF and hepatocellular carcinoma (HCC) dropout at 1-year by 49•1% and 107•96% respectively. When only urgent LT was allowed, HCC dropout and ACLF incidence were comparable to the rates seen in the scenario of complete LT cessation. Interpretation: A short and wide-ranging disruption to LT results in better outcomes compared with a longer duration of partial restrictions. Funding: None to disclose.
format	article
author	Eunice Xiang-Xuan Tan Wei Liang Quek Suryadi Haroun Chahed Shridhar Ganpathi Iyer Prema Raj Jeyaraj Guan-Huei Lee Albert Chan Stephanie Cheng Jan Hoe Ek Khoon Tan Lock Yue Chew James Fung Melvin Chen Mark D. Muthiah Daniel Q. Huang
author_facet	Eunice Xiang-Xuan Tan Wei Liang Quek Suryadi Haroun Chahed Shridhar Ganpathi Iyer Prema Raj Jeyaraj Guan-Huei Lee Albert Chan Stephanie Cheng Jan Hoe Ek Khoon Tan Lock Yue Chew James Fung Melvin Chen Mark D. Muthiah Daniel Q. Huang
author_sort	Eunice Xiang-Xuan Tan
title	Impact of COVID-19 on Liver Transplantation in Hong Kong and Singapore: A Modelling Study
title_short	Impact of COVID-19 on Liver Transplantation in Hong Kong and Singapore: A Modelling Study
title_full	Impact of COVID-19 on Liver Transplantation in Hong Kong and Singapore: A Modelling Study
title_fullStr	Impact of COVID-19 on Liver Transplantation in Hong Kong and Singapore: A Modelling Study
title_full_unstemmed	Impact of COVID-19 on Liver Transplantation in Hong Kong and Singapore: A Modelling Study
title_sort	impact of covid-19 on liver transplantation in hong kong and singapore: a modelling study
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/a27013ff1c79401ca6a3abf485f3a9a1
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Impact of COVID-19 on Liver Transplantation in Hong Kong and Singapore: A Modelling Study

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