Impact of COVID-19 on Liver Transplantation in Hong Kong and Singapore: A Modelling Study.
Eunice Xiang-Xuan Tan, Wei Liang Quek, 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 Information
Eunice Xiang-Xuan Tan: Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.
Wei Liang Quek: School of Humanities, Nanyang Technological University, Singapore.
Suryadi: School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore.
Haroun Chahed: School of Humanities, Nanyang Technological University, Singapore.
Shridhar Ganpathi Iyer: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Prema Raj Jeyaraj: SingHealth Duke-NUS Transplant Centre, Singapore.
Guan-Huei Lee: Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.
Albert Chan: Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation, Department of Surgery, The University of Hong Kong, China.
Stephanie Cheng: Department of Hepato-pancreato-biliary and Transplant Surgery, Singapore General Hospital, Singapore.
Jan Hoe: National University Centre for Organ Transplantation, National University Health System, Singapore.
Ek Khoon Tan: SingHealth Duke-NUS Transplant Centre, Singapore.
Lock Yue Chew: School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore.
James Fung: Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Melvin Chen: School of Humanities, Nanyang Technological University, Singapore.
Mark D Muthiah: Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.
Daniel Q Huang: Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.
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.
