COVID-19 infection requires strengthening of the chronic care model: the impact on liver transplant practice at a high-volume center in Italy

Spreading of SARS-CoV-2 infection in Italy has challenged the practice of liver transplantation in an unprecedented way. We report on the initiatives implemented at a high-volume transplant center to handle an anticipated increase in waiting list time, deferral of pre-transplant care and temporary postponement of routine post-transplant follow up. In March 2020 liver transplant procedures decreased by 57% over the previous month, however with no change in laboratory MELD or outcome. No waitlist mortality was observed. Three patients declined transplantation for fear of COVID-19. Two liver transplant recipients were diagnosed with SARS-CoV-2 infection, and 2 waitlist candidates tested positive. Our outpatient program was switched to a remote, e-assistance model, with 517 e-mail contacts from transplant patients (i.e. 59.1% increase) and 712 patient laboratory tests faxed (45.0% increase). No health care worker was diagnosed with COVID-19 thanks to implementation of social distancing and routine use of individual safety devices. All of the strategies we implemented were derived from the chronic care model and based on productive interaction across healthcare professionals, communities, authorities and patients.