*Purpose: National demand for liver transplants is increasing steadily, with 8,896 liver transplants performed in the USA in 2019, a 7.8% increase from 2018. The number of patients being waitlisted for liver transplant has also increased, with 12,106 waitlisted as of 11/2020. Our own transplant center saw an increase in the number of transplants from 78 (2018) to 145 (2019). The purpose of this study was to evaluate the number and location of liver transplant evaluations in a growing liver transplant program with increased volumes of patient referrals and the utilization of a transitional care clinic.

*Methods: We included all adult patients referred for transplant evaluation at our center from 2018-2019 in our electronic medical records. The data was analyzed in SPSS, with significance testing performed with Fisher’s exact and Pearson’s chi-squared tests. A p-value of less than 0.05 was considered significant. For patients with multiple evaluation encounters, only the most recent encounter was used for analysis. For patients with multiple transplants, only the first encounter was used.

*Results: There was an increase in the number of referred patients from 299 (2018) to 371 (2019). The duration from referral to evaluation decreased from 30 days (2018) to 21 days (2019), p<0.001. We found significantly decreased waitlist mortality, with 16 deaths in 2018 vs. eight deaths in 2019, p=0.035. The location of the evaluation initiation (in-patient vs. out-patient) differed from 2018 (69 in-patient vs. 230 out-patient) compared with 2019 (127 in-patient vs. 244 out-patient), p=0.002. There were significant differences in the social evaluation results with an increase in the number of incomplete evaluations (47 vs. 96) and the number of higher risk evaluations (48 vs. 84) in the two respective years of the study, p=<0.001. Lastly, there were differences in the number of psychological evaluations not completed in 2018 (53) vs. 2019 (172), p=0.001.

*Conclusions: We observed statistically significant decreases in important metrics including waitlist mortality and referral to evaluation time. This is despite an increase in the number of patients deemed intermediate to high social risk, as well as an increase in the number of candidates seen initially as inpatients. The observed results correspond with the implementation of a transitional care clinic in January 2019, which provides two-week follow-up after inpatient admission and continuous outpatient monitoring. We hypothesize this clinic played a role in managing the higher load of inpatient transplant candidates and transitioning them to outpatient evaluations, producing the observed decrease in waitlist mortality and likely reducing costs.

« Back to 2021 American Transplant Congress