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Telehealth identifies liver transplantation noncandidates

Telehealth-based evaluations identified patients with chronic liver disease who were not candidates for liver transplantation without the need for additional testing, according to a study published in Clinical Gastroenterology and Hepatology.

“Because of limited access to transplant centers, patients often travel long distances to be evaluated for [orthotopic liver transplant],” Venkata Rajesh Konjeti, MD, from the Virginia Commonwealth University, and colleagues wrote. “Our data indicate that a telehealth-based triage reduces futile transplant evaluations by approximately 60%.”

To increase access to specialty care, the Department of Veterans Affairs introduced the Specialty Care Access Network–Extension of Community Healthcare Outcomes (SCAN-ECHO) program, designed to offer gastroenterology and hepatology subspecialty telehealth evaluations.

“SCAN-ECHO offers an option for the referring provider to obtain a preliminary analysis of candidacy before completing a full work-up,” the researchers wrote.

The study comprised 190 patients who were referred for transplantation between August 2012 and September 2016, 91 of whom presented through the SCAN-ECHO program and the rest referred directly.

Patients evaluated through SCAN-ECHO were less likely to be deemed noncandidates for transplantation at the time of initial referral (0% vs. 41%; P < .001) and after a complete liver transplantation work-up (23.1% vs. 55.6%; P < .001).

Fewer patients in the SCAN-ECHO group were turned down for transplantation because of psychosocial issues (4.4% vs. 14.1%; P = .02), comorbidities (7.7% vs. 11.1%), or progression of HCC beyond Milan (6.6% vs. 13.1%).

“We believe that expanding SCAN-ECHO to other solid-organ transplant centers within the VA and elsewhere has the potential to improve access, reduce costs, and minimize futile testing of patients,” Konjeti and colleagues wrote. – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.