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P9.01 Impact of the pandemic on liver transplantation and use of telemedicine – clinical hospital UNICAMP

Ilka FSF Boin, Brazil

Full Professor
Unit of Liver Transplantation
University of Campinas

Biography

Bachelor's at Medicina from Universidade Estadual de Campinas (1979), Master's at Surgery from Universidade Estadual de Campinas (1991) and Doctorate at Surgery from Universidade Estadual de Campinas (1997), PhD in Transplantationj and Liver Surgery (2007), Full Professor at Surgical Dept at School of Medicine - State University of Campinas(2014). Has experience in Medicine, focusing on Gastroenterologic Surgery, acting on the following subjects:  liver transplantation, microchimerism, infection, nutrition, phisyotherapy, hemotherapy and cellular terapy correlating to transplantation. Brazilian Joournal of Transplantantion Chef Editor-in-Chief, Member of  Brazilian Liver Transplant Chamber, Member of Sao Paulo Liver transplant Chamber

Abstract

Impact of the pandemic on liver transplantation and use of telemedicine – clinical hospital UNICAMP

Ilka Boin1, Elaine Ataide1, Simone Perales1, Alexandre Foratto1, Debora Puzzi1, Talita Colado1, Celia Souza1, Juliana Elias1, Raquel Stucchi1.

1Unit of Liver Transplantation, Unicamp, Campinas, Brazil

Introduction: The covid-19 pandemic has led to changes in the care of transplant patients, including authorization from the SNT/MS/Brazil for its use since April 2020.

Objective: To assess the impact of COVID-19 on kidney and liver transplantation and the use of telemedicine.

Method: To verify the number of visits, number of transplants, types of assessments, incidence of COVID-19 in transplant recipients, use of immunosuppression and impact on the number of transplants, descriptive statistics were used.

Result: A specific TCLE was implemented for the pandemic season, teleguidance and teleconsultations were carried out institutionally with medical, nursing, psychology and social assistance assessments, the return frequency changed thanks to the 6-month LME (saving in TFD about 20 thousand/patient). 4,000 consultations were carried out in 2020, with a 50% drop in face-to-face consultations (4 outpatient clinics/week) with directed anamnesis, the sending of images and outpatient results was done by institutional email as well as renewal of the MELD (for patients in list). There was a 25% reduction in the number of transplants (lack of an ICU bed and patient refusal due to fear/fear), a 50% drop in the number of patients enrolled in the list. The immunosuppression adjustment was mainly performed in the second wave (November 2020 to March 2021). We observed 30 COVID cases in 750 follow-up liver transplants and 100 cases in 3000 follow-up kidney transplants. In liver transplantation the mortality was 25% and in kidney transplantation it was 26%. The most frequent comorbidities were age > 60 years, presence of diabetes and time greater than ten years after transplantation. 2 patients with COVID-19 and 2 with kidney transplants were transplanted with liver, which evolved well and there was 1 patient transplanted due to complications after IVM/COVID-19 who also evolved well.

Conclusion: COVID-19 had a high impact on transplantation in our service and telemedicine is probably here to stay.

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