Singh Shweta A, Pampaniya Hetal, Kumar Vikram, Kumar Mukesh, Jadaun Shekhar Singh, Yadav Vivek, Saigal Sanjiv, Gupta Subhash
Department of Anaesthesiology and Critical Care, Center for Liver and Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi, India.
Department of Paediatric Gastroenterology and Hepatology, Center for Liver and Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi, India.
Korean J Transplant. 2022 Jun 30;36(2):127-135. doi: 10.4285/kjt.22.0017.
High-volume centers (HVCs) are classically associated with better outcomes. During the coronavirus disease 2019 (COVID-19) pandemic, there has been a decrease in the regular liver transplantation (LT) activity at our center. This study analyzed the effect of the decline in LT on posttransplant patient outcomes at our HVC.
We compared the surgical outcomes of patients who underwent LT during the COVID-19 pandemic lockdown (April 1, 2020 to September 30, 2020) with outcomes in the pre-pandemic calendar year (April 1, 2019 to March 31, 2020).
During the 6 months of pandemic lockdown, 60 patients underwent LT (43 adults and 17 children) while 228 patients underwent LT (178 adults and 50 children) during the pre-pandemic calendar year. Patients in the pandemic group had significantly higher model for end-stage liver disease (MELD) scores (24.39±9.55 vs. 21.14±9.17, P=0.034), Child-Turcotte-Pugh scores (11.46±2.32 vs. 10.25±2.24, P=0.03), and incidence of acute-on-chronic liver failure (30.2% vs. 10.2%, P=0.002). Despite performing LT in sicker patients with COVID-19-related challenges, the 30-day (14% vs. 18.5%, P=0.479), 3-month (16.3% vs. 20.2%, P=0.557), and 6-month mortality rates (23.3% vs. 28.7%, P=0.477) were lower, but not statistically significant when compared to the pre-pandemic cohort.
During the COVID-19 pandemic lockdown the number of LT procedures performed at our HVC declined by half because prevailing conditions allowed LT in very sick patients only. Despite these changes, outcomes were not inferior during the pandemic period compared to the pre-pandemic calendar year. Greater individualization of patient care contributed to non-inferior outcomes in these sick recipients.
高容量中心（HVCs）通常与更好的治疗效果相关。在2019年冠状病毒病（COVID-19）大流行期间，我们中心的常规肝移植（LT）活动有所减少。本研究分析了肝移植活动减少对我们高容量中心肝移植术后患者结局的影响。
我们比较了在COVID-19大流行封锁期间（2020年4月1日至2020年9月30日）接受肝移植患者的手术结局与大流行前日历年（2019年4月1日至2020年3月31日）的结局。
在大流行封锁的6个月期间，有60例患者接受了肝移植（43例成人和17例儿童），而在大流行前日历年有228例患者接受了肝移植（178例成人和50例儿童）。大流行组患者的终末期肝病模型（MELD）评分显著更高（24.39±9.55对21.14±9.17，P=0.034），Child-Turcotte-Pugh评分（11.46±2.32对10.25±2.24，P=0.03），以及慢加急性肝衰竭的发生率（30.2%对10.2%，P=0.002）。尽管在患有与COVID-19相关挑战的病情较重的患者中进行了肝移植，但30天（14%对18.5%，P=0.479）、3个月（16.3%对20.2%，P=0.557）和6个月死亡率（23.3%对28.7%，P=0.477）较低，但与大流行前队列相比无统计学差异。
在COVID-19大流行封锁期间，我们高容量中心进行的肝移植手术数量减少了一半，因为当时的情况只允许在病情非常严重的患者中进行肝移植。尽管有这些变化，但与大流行前日历年相比，大流行期间的结局并不差。对患者护理进行更大程度的个体化有助于这些病情较重的受者获得非劣效的结局。
