Inferior outcomes of liver transplantation for hepatocellular carcinoma during early-COVID-19 pandemic in the United States
作者机构：Department of SurgeryWestchester Medical CenterValhallaNY 10595United States Department of MedicineWestchester Medical CenterValhallaNY 10595United States
出 版 物：《World Journal of Hepatology》 (世界肝病学杂志（英文版）（电子版）)
年 卷 期：2023年第15卷第4期
页 面：554-563页
学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学]
主 题：Liver transplantation Hepatocellular carcinoma COVID-19 Mortality Graft failure United Network for Organ Sharing database
摘 要：BACKGROUND Early in the coronavirus disease 2019(COVID-19)pandemic,there was a significant impact on routine medical care in the United States,including in fields of transplantation and *** To analyze the impact and outcomes of early COVID-19 pandemic on liver transplantation(LT)for hepatocellular carcinoma(HCC)in the United *** WHO declared COVID-19 as a pandemic on March 11,*** retrospectively analyzed data from the United Network for Organ Sharing(UNOS)database regarding adult LT with confirmed HCC on explant in 2019 and *** defined pre-COVID period from March 11 to September 11,2019,and early-COVID period as from March 11 to September 11,*** Overall,23.5%fewer LT for HCC were performed during the COVID period(518 vs 675,P0.05).This decrease was most pronounced in the months of March-April 2020 with a rebound in numbers seen from May-July *** LT recipients for HCC,concurrent diagnosis of non-alcoholic steatohepatitis significantly increased(23 vs 16%)and alcoholic liver disease(ALD)significantly decreased(18 vs 22%)during the COVID *** age,gender,BMI,and MELD score were statistically similar between two groups,while waiting list time decreased during the COVID period(279 days vs 300 days,P=0.041).Among pathological characteristics of HCC,vascular invasion was more prominent during COVID period(P0.01),while other features were the *** the donor age and other characteristics remained same,the distance between donor and recipient hospitals was significantly increased(P0.01)and donor risk index was significantly higher(1.68 vs 1.59,P0.01)during COVID *** outcomes,90-day overall and graft survival were the same,but 180-day overall and graft were significantly inferior during COVID period(94.7 vs 97.0%,P=0.048).On multivariable Coxhazard regression analysis,COVID period emerged as a significant risk factor of post-transplant mortality(Hazard ratio 1.85;95%CI:1.28-2.68,P=0.001).CONCLUSION Durin
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