P091 A coordinated national response maintained a safe and effective UK liver transplant program during the first year of the COVID-19 pandemic

Abstract

<h3>Background</h3> UK healthcare provision has been severely affected by the COVID-19 pandemic, with specific challenges in liver transplantation (LT). Here, we describe the co-ordinated response to, and impact of, the first year of COVID, across all 7 adult and 3 paediatric UK LT centres. <h3>Methods</h3> A series of national policy changes affecting the LT process were agreed. A ‘high-urgent’ (HU) category was established, prioritising for LT those with UKELD &gt;60, HCC reaching transplant criteria, and others likely to die within 90 days. Donor age restrictions and changes to offering were phased throughout the year. These changes were flexed in response to the ‘first wave’ (implemented: March–July 2020) and ‘second wave’ (implemented: Jan–April 2021). During the second wave, organ and patient ‘back-up’ arrangements were introduced, selected centres were designated ‘protected’ by NHSE and some patient care was transferred between centres, when overwhelmed critical care necessitated temporary unit closures. <h3>Results</h3> During 2020/21, there was a significant fall in the total number of annual liver donors (21%; 870 from 1088) and transplants (22% 749 from 950) compared to 5-year mean, prior to the pandemic. This was exclusively amongst adult recipients (23%; 672, vs 868), both elective (22%; 609 vs 778) and SU (30%; 63 vs 90), whilst paediatric activity was maintained (77 vs 81). The reduction in adult LT varied widely geographically (-3 to -43%). LT registrations fell (11%; 1063 vs 1208), again with wide geographic variation (0 to -24%). During the ‘first wave’, we successfully prioritised those with highest illness severity with no reduction in 90d patient (p=0.89) or graft survival (p=0.98). There was a small (5% cf 3%) but significant (p=0.0015) increase in deaths/removals from the UK LT waitlist, during this time. During the ‘second wave’, 5 adult units temporarily closed at various times, whilst 3 ‘protected’ LT centres were maintained at any time. Consequently, 25 waitlist registrants were transferred to protected centres with 10 undergoing LT outwith their original centre. <h3>Discussion</h3> A sophisticated national response has maintained a safe and effective UK LT program throughout the first year of COVID. We adapted our resources, implementing phased donor restrictions and a new category for recipient prioritisation. Patients benefitted from collaborative working, enabling those in most need to be transferred and transplanted in protected centres. Consequently, we mitigated against a significant fall in LT activity. Our collaborative response serves as an as exemplar for other specialist healthcare services.