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LIVER TRANSPLANTATION IN THE TIME OF A PANDEMIC: A WIDENING OF THE RACIAL AND SOCIOECONOMIC HEALTH CARE GAP DURING COVID-19
*Malcolm MacConmara1, *Benjamin Wang1, *Madhukar S Patel2, *Christine S Hwang1, *Lucia DeGregorio1, *Jigesh Shah1, *Steven I Hanish1, Dev Desai1, *Raymond Lynch3, *Bekir Tanriover4, Herbert Zeh, III1, *Parsia A Vagefi1
1University of Texas Southwestern Medical Center, Dallas, TX;2University of Toronto, Toronto, ON, Canada3Emory University, Atlanta, GA;4University of Arizona, Tuscon, AZ

OBJECTIVE(S): During the initial wave of the COVID-19 pandemic, organ transplantation was classified a CMS Tier 3b procedure which should not be postponed. The differential impact of the pandemic on access to liver transplantation was assessed.
METHODS: Using UNOS STARfile data, adult waitlisted candidates were identified from 03/01/2020 - 05/31/2020 (n=15293, pandemic) and 03/01/2019 - 05/31/2019 (n=16356, pre-pandemic). Comparisons between pandemic and pre-pandemic groups included- minority status, demographics, diagnosis, MELD, insurance type and transplant center characteristics. Liver transplant centers (n=113) were divided into tertiles by volume (small, medium, large) for further analyses. Multivariable logistic regression was fitted to assess odds of transplant.
RESULTS: During the pandemic, minorities showed greater reduction in both listing (-14% vs -12% Caucasians), and transplant (-15% vs -7% Caucasians), despite a higher median MELD at transplant (23 vs 20 Caucasians, p<0.001). Of candidates with public insurance, minorities demonstrated an 18.5% decrease in transplant during the pandemic (vs -8% Caucasians). The adjusted odds ratio of transplant during the pandemic for minorities was 0.87 (CI, 0.78 - 0.97 p=0.012). Although large programs increased transplants during the pandemic - accounting for 61.5% of liver transplants (vs 53.4% pre-pandemic (p<0.001)), minorities comprised significantly fewer transplants at these programs (27.7% pandemic vs 31.7% pre-pandemic, (p=0.04)).
CONCLUSIONS: COVID-19ís effect on access to liver transplantation has been ubiquitous. However, minorities, especially those with public insurance, have been disproportionately affected. As the pandemic persists, and the aftermath ensues, health care systems must consciously strive to identify and equitably serve vulnerable populations.


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